(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 will remove your domestic partner from coverage.
- Domestic partner child(ren) must be removed.
- You may enroll in coverage or add your children that lost coverage under your deceased domestic partner’s plan.
- You may change your health plan if you are adding your children that lost coverage under the deceased domestic partner’s plan.
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| Dental Insurance |
- You will remove your domestic partner from coverage.
- Domestic partner child(ren) must be removed.
- You may enroll in coverage or add your children that lost coverage under your deceased domestic partner’s plan.
|
| 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 as of the date of the event.
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| Dependent Care FSA |
- You may increase or decrease contributions if event increases or decreases dependent care expenses or causes loss of coverage under your domestic partner's plan.
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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.
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Updated 10/2019
