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Change in Status of Unmarried Dependents Including Moving Out of EPO Service Area
**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? |
Marriage
Attainment of limiting age
Student status
Dependency |
Drop dependent no longer eligible
Add newly eligible dependents |
Change health option | Yes, marriage certificate;
No, attainment of limiting age;
Yes, student status verification
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| Change in work site | Change to newly eligible plan
Change to another health option
Cancel all health coverage |
Change coverage level (e.g. single to family) |
No, if University employee and address changed on payroll system |
| Court judgement/decree/order |
Add/drop dependent in accordance with decree |
Change coverage except as required by decree |
yes (Court order) |
| Entitlement ot Medicare or Medicaid (AHCCCS) |
Cancel coverage of individual eligible for Medicare or Medicaid (AHCCCS) |
Change coverage for non-Medicare or non-Medicaid (AHCCCS) eligible individuals |
yes (Medicare, Medicaid or AHCCCS enrollment information) |
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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
