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Change in Number of Eligible Dependents Including Death
**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 (if spouse state employee) |
Decrease flex spending
Drop spouse
Drop child(ren)
Decrease life
Drop employee coverage (if spouse not state employee) |
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 |
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| Who To Contact |
Rates |
FAQ's |
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© 2005, Arizona Board of Regents
University of Arizona | University Services Building, 888 N. Euclid Avenue, Room 114, Tucson, AZ 85721-0158
520.621.3662 (phone) | 520.621.9098 (fax) | Page last updated June 12, 2007
