Termination of Domestic Partnership

(You must complete the Affidavit of Termination of Domestic Partnership form.)

Health Insurance
  • You must remove your former domestic partner and domestic partner’s eligible family members from coverage.

Dental Insurance
  • You must remove your former domestic partner and domestic partner’s eligible family members from coverage.

Health FSA
  • You may decrease your contribution to reflect loss of your domestic partner and domestic partner’s eligible family members as long as they are tax dependents.

Dependent Care FSA
  • You may decrease your contribution if event decreases dependent care expenses for domestic partner’s eligible family members as long as they are tax dependents.

Supplemental Life Insurance
  • No change is allowed.