Qualified Life Events
You can make changes to certain benefit elections during the year only if you experience a life event. You can request changes that are consistent with your life event by making changes to your benefit elections within 30 days after the date of the event (60 days for birth and adoption for health and dental.) Depending upon the life event, you may be required to submit documentation of the event. If you do not make the changes in a timely manner, you will not be able to change your benefits until the next annual open enrollment. Contact your Human Resources Associate for assistance in making timely changes.
Experiencing a Change? Remember to Update Your Beneficiary
Remember to review your beneficiary designations for life insurance and your RIC account and make updates as necessary whenever you experience a life event that changes your eligible dependents, for example a marriage or divorce, or the birth or adoption of a child.
- See the Managing Benefits Smart Guide for assistance.
Here are a few of the most common types of qualifying life events.
- Change in Marital Status or number of Dependents
- Change in Your Employment Status
- Leave of Absence
- You or Your Spouse’s Retirement
Interactive Life Event Matrix
Download or print a copy of the Life Events Matrix.
Change in Your Legal Marital Status
Health Insurance
- You may enroll in coverage and/or add eligible 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 spouse’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may enroll in coverage and/or add eligible family members.
- You may cancel your coverage if you become covered by your spouse’s dental plan.
Health FSA
- You may enroll, increase, or decrease your contribution.
- You may cancel your contribution if you become covered by your spouse’s health FSA plan.
Dependent FSA
- You may enroll or increase contribution if marriage increases dependent care expenses.
- You may decrease contributions if the family elects dependent care assistance under spouse’s plan or marriage decreases dependent care expenses.
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.
Form required - Affidavit of Common Law Marriage
Health Insurance
- You may enroll in coverage and/or add eligible 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 spouse’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may enroll in coverage and/or add eligible family members.
- You may cancel your coverage if you become covered by your spouse’s dental plan.
Health FSA
- You may enroll, increase, or decrease your contribution.
- You may cancel your contribution if you become covered by your spouse’s health FSA plan.
Dependent FSA
- You may enroll or increase contribution if marriage increases dependent care expenses.
- You may decrease contributions if the family elects dependent care assistance under spouse’s plan or marriage decreases dependent care expenses.
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.
Form required - Declaration of Domestic Partnership
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.
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.
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.
Dependent FSA
- You may enroll or increase your 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.
- 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.
Only allows removal of spouse from health and dental coverage.
Form required - Divorce Decree
Health Insurance
- You must remove your former spouse and former spouse’s eligible family members from coverage.
- You cannot remove other dependents from coverage unless they are added to your former spouse’s plan.
- You may enroll yourself in coverage and add dependents if the event causes loss of coverage under former spouse’s plan.
- You may change your health plan if you are adding dependents that lost coverage under your former spouse’s plan.
Dental Insurance
- You must remove your former spouse and former spouse’s eligible family members from coverage.
- You cannot remove other dependents from coverage unless they are added to your former spouse’s plan.
- You may enroll yourself in coverage and add dependents if the event causes loss of coverage under former spouse’s plan.
Health FSA
- You may decrease your contribution to reflect loss of your spouse’s eligibility.
- You may enroll or increase your contribution if coverage is lost under your spouse’s health or health FSA plan.
Dependent FSA
- You may enroll or increase contributions if event increases dependent care expenses or causes loss of coverage under spouse’s plan.
- You may decrease contributions if event decreases dependent care expenses.
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.
Form required - Termination of Domestic Partnership
Health Insurance
- You must remove your former domestic partner and domestic partner’s family members from coverage.
Dental Insurance
- You must remove your former domestic partner and domestic partner’s 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 FSA
- You may decrease contributions if event decreases dependent care expenses for domestic partner’s eligible family members as long as they are tax dependents.
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.
Health Insurance
- You will remove your spouse from coverage.
- You may enroll in coverage or add your children that lost coverage under your deceased spouse’s plan.
- You may change your health plan if you are adding your children that lost coverage under your deceased spouse’s plan.
Dental Insurance
- You will remove your spouse from coverage.
- You may enroll in coverage or add your children that lost coverage under your deceased spouse’s plan.
Health FSA
- You may decrease your contribution to reflect loss of your spouse.
- You may enroll or increase your contribution if coverage is lost under your deceased spouse’s plan.
Dependent FSA
- You may increase contributions if event increases dependent care expenses or causes loss of coverage under your deceased spouse’s plan.
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.
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 your deceased domestic partner’s plan.
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 contributions to reflect loss of your domestic partner and domestic partner’s eligible family members as long as they were tax dependents as of the date of the event.
Dependent 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.
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.
Change in the Number of Your Dependents
Documentation Required
Adoption
- Adoption decree/order with judge's signature and circuit clerk's file stamp, or Petition for adoption with circuit clerk's file stamp, or Letter of placement by an adoption agency.
Legal Guardianship
Court document signed by judge and stamped by the circuit clerk showing legal guardianship.
Health Insurance
- You may enroll yourself or add newly eligible dependent, spouse, and other dependents.
- You may also change your health plan if you are adding eligible family members.
- You may cancel coverage if you become covered by your spouse’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may enroll yourself or add newly eligible dependent, spouse, and other dependents.
- You may cancel your coverage if you become covered by your spouse’s dental plan.
Health FSA
- You may enroll to contribute, continue your contribution, or increase your contribution.
Dependent FSA
- You may enroll to contribute, continue contributions, or increase your contribution if the event increases dependent care expenses.
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.
Health Insurance
- You may add the newly eligible domestic partner’s dependent.
- You may also change your health plan.
Dental Insurance
- You may add the newly eligible domestic partner’s dependent.
Health FSA
- You may enroll or increase your contribution if your domestic partner and eligible domestic partner’s family members are tax dependents.
Dependent FSA
- You may enroll or increase your contribution if the eligible domestic partner’s family members are tax dependents.
Supplemental Life Insurance
- If the Domestic Partner's dependent is the employee's tax dependent, you may enroll or increase the amount of your coverage. Satisfactory evidence of insurability is required.
Health Insurance
- You may only cancel coverage for dependent no longer eligible.
Dental Insurance
- You may only cancel coverage for dependent no longer eligible.
Health FSA
- You may decrease or cancel contribution.
Dependent FSA
- No change is allowed.
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.
Form Required - Domestic Partnership Cancellation of Health and Dental Coverage
Health Insurance
- You may only cancel coverage for dependent no longer eligible.
Dental Insurance
- You may only cancel coverage for dependent no longer eligible.
Health FSA
- You may decrease or cancel contribution if the eligible domestic partner’s family members are tax dependents.
Dependent FSA
- You may decrease or cease the election if the dependent reaches the age of 13 or becomes capable of self-care, if the domestic partner and dependent are tax dependents.
Supplemental Life Insurance
- If the Domestic Partner's dependent is the employee's tax dependent, 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.
Forms Required - Certification of Full-Time Student Status
Health Insurance
- You may enroll the newly eligible dependent.
Dental Insurance
- You may enroll the newly eligible dependent.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
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.
Forms Required - Domestic Partnership Re-enrollment in Health and Dental Insurance AND Certification of Full-Time Student Status
Health Insurance
- You may enroll the newly eligible domestic partner’s dependent.
- You must complete the Domestic Partnership Dependent Reenrollment form.
Dental Insurance
- You may enroll the newly eligible domestic partner’s dependent.
- You must complete the Domestic Partnership Dependent Reenrollment form.
Health FSA
- No change allowed.
Dependent FSA
- No change allowed.
Supplemental Life Insurance
- If the Domestic Partner's dependent is the employee's tax dependent, 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.
Health Insurance
- You may only cancel coverage for the deceased member.
Dental Insurance
- You may only cancel coverage for the deceased member.
Health FSA
- You may decrease contribution or cancel contribution.
Dependent FSA
- You may decrease contribution or cancel contribution if you have reduced dependent care expenses.
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.
Change in Your Employment Status
Health Insurance
- You may change your health plan only if your current health plan is not offered as a result of the change in bargaining status or elect the health insurance opt-out.
- You may cancel coverage.
- If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may cancel coverage.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- You may increase or decrease coverage if the benefits are different between the bargaining classes.
- If increasing coverage, satisfactory evidence of insurability is required.
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Health Insurance
- Coverage for you and eligible family members ceases at the end of the month in which coverage is lost.
- You may pay for continued coverage through COBRA for up to 18 months, if not eligible for Medicare.
Dental Insurance
- Coverage for you and eligible family members ceases at the end of the month in which coverage is lost.
- You may pay for continued coverage through COBRA for up to 18 months.
Health FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
- You may continue participation on an after-tax basis through COBRA.
Dependent FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee or while you are employed elsewhere or looking for employment.
Supplemental Life Insurance
- Your coverage ceases at the end of the month in which coverage is lost.
- You may pay for continued coverage under the conversion or portability provisions.
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Permanent change in scheduled hours from 40 hours per week to 20 – 29 hours per week.
Health Insurance
- If enrolled, you may cancel coverage.
- If enrolled in family coverage, you may cancel eligible family members.
- You may change your health plan.
Dental Insurance
- If enrolled, you may cancel coverage.
- If enrolled in family coverage, you may may cancel eligible family members.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- Your coverage ceases at the end of the month in which coverage is lost.
- You may pay for continued coverage under the conversion or portability provisions.
Permanent change in scheduled hours from 40 hours per week to less than 20 per week (less than 30 hours for life insurance).
Health Insurance
- Coverage for you and your dependents ceases at the end of the month.
- You may pay for continued coverage through COBRA for up to 18 months, if not eligible for Medicare.
Dental Insurance
- Coverage for you and your dependents ceases at the end of the month.
- You may pay for continued coverage through COBRA for up to 18 months.
Health FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
- You may continue participation on an after-tax basis through COBRA, if eligible.
Dependent FSA
- Contributions cease.
Supplemental Life Insurance
- Your coverage ceases at the end of the month.
- You may pay for continued coverage under the conversion or portability provisions.
Change in scheduled hours from less than 20 hours per week to 20 – 40 hours per week (health, dental and FSA); 30 – 40 hours per week (life insurance).
Health Insurance
- You may enroll you and your eligible family members in coverage.
Dental Insurance
- You may enroll you and your eligible family members in coverage.
Health FSA
- You may enroll in coverage.
Dependent FSA
- You may enroll in coverage.
Supplemental Life Insurance
- You may enroll in coverage.
Health Insurance
- You may enroll you and your eligible family members in coverage.
- If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may enroll you and your eligible family members in coverage.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- You may enroll in coverage.
Health Insurance
- Reinstate to prior plan election or you may make a new election similar to a new hire.
Dental Insurance
- Reinstate to prior plan election or you may change your coverage level.
Health FSA
- Reinstate prior contribution.
Dependent FSA
- Reinstate prior contribution.
Supplemental Life Insurance
- Reinstate prior contribution.
Change in your Spouse’s or Dependent’s Status
Health Insurance
- You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse’s plan.
- You may change your health plan if you are adding dependents that lost coverage under your spouse’s former plan.
Dental Insurance
- You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse’s plan.
Health FSA
- You may enroll or increase contribution if spouse’s termination adversely affects eligibility for coverage under spouse’s health or health care FSA plan.
Dependent FSA
- You may enroll or increase coverage if you lost coverage under your spouse's FSA plan.
- You can also cancel coverage, or decrease contribution if your spouse’s termination decreases dependent care expenses.
Supplemental Life Insurance
- You may enroll in or increase life coverage if your spouse is no longer employed which resulted in a loss of group life insurance. Satisfactory evidence of insurability is required.
- You may cancel or decrease the amount of your coverage.
Health Insurance
- You may cancel coverage for you and/or eligible family members if you become covered by spouse’s health plan. If cancelling your coverage, you may elect the health insurance opt-out if eligible.
Dental Insurance
- You may cancel coverage for you and/or eligible family members.
Health FSA
- You may decrease contributions if spouse becomes covered under health or health care FSA plan.
Dependent FSA
- You may enroll or increase contributions if event increases dependent care expenses.
- You may cease or decrease if you become eligible for Spouse's FSA plan.
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.
Health Insurance
- You may cancel coverage for the dependent commencing employment.
Dental Insurance
- You may cancel coverage for the dependent commencing employment.
Health FSA
- You may decrease contributions if dependent becomes covered under health or health care FSA plan.
Dependent FSA
- You may enroll or increase contributions if event increases dependent care expenses.
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.
Health Insurance
- You may enroll yourself or add spouse and other eligible dependents.
- You may also change your health plan if you are adding eligible family members.
- You may cancel coverage if you become covered by your spouse’s health plan. If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may enroll yourself or add spouse and other eligible dependents.
- You may cancel coverage if you become covered by your spouse’s dental plan.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Under spouse’s or dependent’s plan (e.g., switch from hourly to salaried status).
Health Insurance
- You may enroll in coverage and/or add eligible family members.
- You may change your health plan if you are adding dependents that lost coverage under your spouse’s former plan.
Dental Insurance
- You may enroll in coverage and/or add eligible family members if they lost coverage under the spouse’s plan.
Health FSA
- You may enroll or increase contribution if spouse’s employment change adversely affects eligibility for coverage under spouse’s health or health care FSA plan.
Dependent FSA
- You may enroll or increase contribution if spouse’s employment change increases dependent care expenses or causes a loss of eligibility for spouse's FSA plan.
- Decrease or cancel contribution if the event decreases dependent care expenses.
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.
Under spouse’s or dependent’s plan (e.g., switch from hourly to salaried status).
Health Insurance
- You may cancel coverage for you and eligible family members if you become covered by spouse’s health plan.
- If cancelling your coverage, you may elect the health insurance opt-out if eligible.
Dental Insurance
- You may cancel coverage for you and eligible family members.
Health FSA
- You may decrease or cease contribution if family becomes covered under health or health care FSA plans of spouse.
Dependent FSA
- You may decrease or cease contribution if family becomes covered under spouse’s dependent care assistance plan.
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.
Health Insurance
- You may enroll in coverage and/or add eligible family members.
- You may change your health plan if you are adding dependents that lost coverage under your spouse's former plan.
Dental Insurance
- You may enroll the spouse in coverage and/or add eligible family members if they lost coverage under the spouse's plan
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
* Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.
Health Insurance
- You may enroll in coverage and/or add eligible family members.
- You may change your health plan if you are adding dependents that lost coverage under your spouse's former plan.
Dental Insurance
- No change is allowed.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
* Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.
Health Insurance
- You may enroll in coverage and/or add eligible family members.
- You may change your health plan if you are adding dependents that lost coverage under your spouse's former plan.
Dental Insurance
- No change is allowed.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
* Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.
Health Insurance
- You may enroll the eligible dependent in coverage.
- You may change your health plan.
Dental Insurance
- No change is allowed.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
* Creditable health coverage is defined in the Health Insurance Protection and Portability Act (HIPPA) as defined in 45 CFR §160.103.
Health Insurance
- You may enroll the eligible dependent in coverage.
- You may change your health plan.
Dental Insurance
- No change is allowed.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Health Insurance
- You may add eligible dependent.
Dental Insurance
- You may add eligible dependent.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
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.
Form Required - /node/1552
Health Insurance
- You may add eligible dependent.
Dental Insurance
- You may add eligible dependent.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Health Insurance
- You may enroll the eligible dependent in coverage.
- You may change your health plan.
Dental Insurance
- You may enroll the eligible dependent in coverage.
Health FSA
- You may enroll or increase contribution to health FSA.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Change in residence of you, your spouse, or your dependent
Health Insurance
- You may change your health plan.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- You may increase or decrease contribution only if child care provider changes.
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.
Health Insurance
- You may change your health plan.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- You may increase or decrease contribution only if child care provider changes.
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.
Health Insurance
- You may enroll in coverage and/or add eligible family members.
Health FSA
- No change is allowed.
Dependent FSA
- You may enroll or increase contribution if spouse’s employment change adversely affects eligibility for coverage under spouse’s health or health care FSA plan.
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.
Health Insurance
- You may change your health plan or cancel coverage if other coverage is available.
- If cancelling your coverage, you may elect the health insurance opt-out if eligible.
Dental Insurance
- No change is allowed.
Health FSA
- You may decrease contribution if spouse or dependent becomes covered under health or FSA plan of spouse or dependent.
Dependent FSA
- You may increase or decrease contribution only if child care provider changes.
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.
Commencing or Returning from a Leave of Absence (including FMLA)
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- Coverage ceases during the leave. You may make a new annual election upon return to employment.
Supplemental Life Insurance
- You may enroll, continue your coverage, or increase the amount of your coverage. If you enroll or increase your coverage, satisfactory evidence of insurability is required.
- You may cancel or decrease the amount of your coverage.
Health Insurance
- You are billed for the total cost of any premiums due. Premiums are paid with after-tax dollars.
- You may change your health plan.
- If enrolled in family coverage, you may change coverage level.
- You may cancel your coverage.
Dental Insurance
- You are billed for the total cost of any premiums due. Premiums are paid with after-tax dollars.
- If enrolled in family coverage, you may change coverage level.
- You may cancel your coverage.
Health FSA
- Contributions and coverage cease.
Dependent FSA
- Contributions and coverage cease.
Supplemental Life Insurance
- You may enroll, continue your coverage, or increase the amount of your coverage. If you elect to continue coverage, you must pay supplemental life insurance premiums to your Human Resources Associate.
- If you enroll or increase your coverage, satisfactory evidence of insurability is required.
- You may cancel or decrease your coverage.
Health Insurance
- You are billed for the total cost of any premiums due. Premiums are paid with after-tax dollars.
- You may change your health plan.
- If enrolled in family coverage, you may change coverage level.
- You may cancel your coverage.
Dental Insurance
- You are billed for the total cost of any premiums due. Premiums are paid with after-tax dollars.
- If enrolled in family coverage, you may change coverage level.
- You may cancel your coverage.
Health FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
- If you wish to retain coverage, you may prepay or you may make payments on an after-tax basis.
Dependent FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were at work.
Supplemental Life Insurance
- You may enroll, continue your coverage, or increase the amount of your coverage.
- If you elect to continue coverage, you must pay supplemental life insurance premiums to your Human Resources Associate.
- If you enroll or increase your coverage, satisfactory evidence of insurability is required.
- You may cancel or decrease your coverage.
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- No change in contributions.
- Coverage ceases.
Supplemental Life Insurance
- No change is allowed.
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Form Required - Military Leave of Absence Request (Exceed 30 Days)
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- Your coverage ceases at the end of the month the military leave begins.
Form Required - Military Leave of Absence Request (Exceed 30 Days)
(if not already submitted when the employee commenced paid military leave)
Health Insurance
- Coverage for you and eligible family members ceases at the end of the month for which the last premium is paid.
- You may pay for continued coverage through COBRA for up to 24 months, if not eligible for Medicare.
Dental Insurance
- Coverage for you and eligible family members ceases at the end of the month for which the last premium is paid.
- You may pay for continued coverage through COBRA for up to 24 months, if not eligible for Medicare.
Health FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
- If you wish to retain coverage, you may prepay with your final check, or may make payments on an after-tax basis.
Dependent FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
Supplemental Life Insurance
- Your coverage ceases at the end of the month the military leave begins.
Health Insurance
- Your health insurance will be reinstated.
- You may elect a different health plan.
- You may change your coverage level.
- You may cancel your coverage.
- If eligible, you may elect the health insurance opt-out.
Dental Insurance
- Your dental insurance is reinstated.
- You may change your coverage level.
- You may cancel your coverage.
Health FSA
- Reinstate prior contribution or make a new election.
Dependent FSA
- Reinstate prior contribution or make a new election.
Supplemental Life Insurance
- Reinstate prior coverage. If you request to increase your coverage, satisfactory evidence of insurability is required.
- You may cancel or decrease the amount of your coverage.
Served with a Judgment, Order or Decree
Including a child of a domestic partner as long as the domestic partner's child is a tax dependent.
Documentation Required - Judgment, decree, or order (including QMCSO)
Health Insurance
- You may add dependent child if required under order.
- You may cancel dependent child coverage if other parent provides coverage under order.
Dental Insurance
- You may add dependent child if required under order.
- You may cancel dependent child coverage if other parent provides coverage under order.
Health FSA
- You may enroll or increase contribution if you add dependent to coverage.
- You may decrease or stop your contributions if the event requires another person to provide health or dental coverage for a dependent.
- Changes relating to a child of a domestic partner may only be made if both the domestic partner and the child are tax dependents.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
You or Your Spouse’s Retirement
Health Insurance
- Coverage, as an active employee, for you and eligible family members ceases at the end of the month in which you retire.
- Eligible for retiree health coverage. You may change your health plan. You must be the policyholder at the time of retirement.
- As a retiree, you may change to single coverage anytime throughout the year.
Dental Insurance
- Coverage, as an active employee, for you and eligible family members ceases at the end of the month in which you retire.
- Eligible for retiree dental coverage. You must be the policyholder at the time of retirement.
- As a retiree, you may change to single coverage anytime during the year.
Health FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
- If you wish to retain coverage, you may prepay with your final check, or if eligible, you may make payments on an after-tax basis through COBRA.
Dependent FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
Supplemental Life Insurance
- Your coverage ceases at the end of the month in which you retire.
- You may pay for continued coverage under the conversion or portability provision.
Health Insurance
- Coverage, as an active employee, for you and eligible family members ceases at the end of the month in which you retire.
- Eligible for retiree health coverage. You may change your health plan. You must be the policyholder at the time of retirement.
- As a retiree, you may change to single coverage anytime throughout the year.
Dental Insurance
- Coverage, as an active employee, for you and eligible family members ceases at the end of the month in which you retire.
- Eligible for retiree dental coverage. You must be the policyholder at the time of retirement.
- As a retiree, you may change to single coverage anytime during the year.
Health FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
- If you wish to retain coverage, you may prepay with your final check, or if eligible, you may make payments on an after-tax basis through COBRA.
Dependent FSA
- Contributions cease. You may continue to submit claims but only for expenses incurred while you were an eligible employee.
Supplemental Life Insurance
- Your coverage ceases at the end of the month in which you retire.
- You may pay for continued coverage under the conversion or portability provision.
Health Insurance
- You may enroll your spouse in coverage.
- You may change your health plan.
Dental Insurance
- Not applicable.
Health FSA
- Not applicable.
Dependent FSA
- Not applicable.
Supplemental Life Insurance
- Not applicable.
Health Insurance
- You may enroll your spouse in coverage.
- You may change your health plan.
Dental Insurance
- You may enroll your spouse in coverage.
Health FSA
- Not applicable.
Dependent FSA
- Not applicable.
Supplemental Life Insurance
- You may enroll in or increase life coverage if your spouse is no longer employed which resulted in a loss of group life insurance. Satisfactory evidence of insurability is required.
- You may cancel or decrease your coverage.
You, your Spouse or Dependent becomes Entitled to Medicare or Medicaid
Health Insurance
- You may cancel coverage for the eligible family member entitled to Medicare or Medicaid.
- You may cancel your coverage if you become covered by Medicare or Medicaid. If eligible, you may elect the health insurance opt-out.
Dental Insurance
- You may cancel coverage for you and the eligible family member entitled to Medicaid.
Health FSA
- You may increase or decrease contribution.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Any group health coverage sponsored by a governmental or educational institution.
Health Insurance
- You may enroll the eligible family member that lost coverage.
Dental Insurance
- You may enroll the eligible family member that lost coverage.
Health FSA
- You may increase your contributions.
Dependent FSA
- No change is allowed.
Supplemental Life Insurance
- No change is allowed.
Change in cost by your Dependent Care Provider
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- You may increase or decrease contribution that corresponds to new costs.
Supplemental Life Insurance
- No change is allowed.
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- You may increase or decrease contribution that corresponds to new costs.
Supplemental Life Insurance
- No change is allowed.
Health Insurance
- No change is allowed.
Dental Insurance
- No change is allowed.
Health FSA
- No change is allowed.
Dependent FSA
- You may increase contribution that corresponds to new costs.
Supplemental Life Insurance
- No change is allowed.
Contact your Human Resources Associate if you have any questions.