(You must complete the Affidavit of Termination of Domestic Partnership form. Contact your Human Resources Associate for assistance in making the change.)
| 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 |
- You may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
- You may cancel or decrease the amount of your coverage.
|
Updated 10/2019
