**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? |
Employment commencement
(i.e. spouse begins employment or obtains new coverage) |
Elect coverage under spouse's plan and drop under employee's plan |
Change health option
Drop coverage, but not elect under spouse's plan |
Yes, Verification of new coverage enrollment |
Terminate employment
(i.e. if spouse terminates employment) |
>Elect coverage under employee's plan
Increase flex spending |
Change state health plan |
Yes, Verification of loss of coverage (i.e. COBRA letter) |
