(You must complete the Affidavit of Domestic Partnership form. Contact your Human Resources Associate for assistance in making the change.)
| Health Insurance |
- You may enroll in coverage and/or add the domestic partner and eligible domestic partner’s family members.
- You may change your health plan if you are adding eligible family members.
- You may cancel coverage if you become covered by your partner’s health plan. If eligible, you may elect the health insurance opt-out.
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| Dental Insurance |
- You may enroll in coverage and/or add the domestic partner and eligible domestic partner’s family members.
- You may cancel your coverage if you become covered by your partner’s dental plan.
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| Health FSA |
- You may enroll or increase your contribution if your domestic partner and eligible domestic partner’s family members, if any, are tax dependents.
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| Dependent Care FSA |
- You may enroll or increase contribution if your domestic partner and eligible domestic partner's family members, if any, are tax dependents.
- You may decrease contributions if your dependent care expenses decrease.
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| Supplemental Life Insurance |
- If the Domestic Partner is a tax dependent, you may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
- If the Domestic Partner is a tax dependent, you may cancel or decrease the amount of your coverage.
- If the Domestic Partner is not a tax dependent, no change allowed.
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Updated 10/2019
