**IMPORTANT** Information provided is intended solely as a guide and is a partial listing of eligible events and corresponding changes. If you have experienced or anticipate experiencing a qualified Life Event change you must notify Human Resources, in writing, within 31 days of the date of the event. For more information, contact Human Resources directly.
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Benefits Election Change Form / Declaration for Change Form (Life Event Change)
(PDF)
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| Status Change | Sample Changes Permitted | Sample Changes NOT Permitted | Documentation Required? |
Birth
Adoption
Placement for adoption
Guardianship
Change in custody (natural or step-children)
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Enroll employee (and family)
Add child(ren)
Add spouse
Elect short-term disability
Increase flex spending
Increase life
Drop employee coverage and elect under spouse's plan |
Decrease flex spending
Drop spouse
Drop child(ren)
Decrease life
Drop employee coverage |
Yes, Birth certificate; Adoption, Guardianship or applicable legal court order |
Death of dependent
Removal of foster child
Removal of custody or guardianship |
Drop coverage of deceased dependent
Decrease flex spending
Elect employee/family coverage if covered under deceased spouse's plan
Decrease life insurance (employee) |
Increase flex spending
Change health option
Increase life insurance (employee) |
Yes, death certificate or court order |
