If you experience a life-changing event, you may need to change your current health-plan enrollment status or update your dependents.
What Qualifies as a Life-Changing Event?
- Legal separation or divorce
- Birth or adoption
- Losing or gaining health coverage for yourself or dependents
- Death of an eligible dependent
When Do Benefit Changes Become Effective When Reporting a Life-Changing Event?
When Life-Changing Event is Reported
|When Benefit Changes are Effective|
|Within 30 days of event
||Date of life event
|After 30 days and no later than 90 days of the event||The first of the following month|
|After 90 days of the event||Must wait until the next Open Enrollment|
How to Change Coverage or Dependent InformationSubmit the following form and supporting documentation
- Retiree Health Program Enrollment/Change Form
- One copy of required supporting documentation (birth certificate, adoption decree, marriage certificate, legal separation papers, divorce decree, or death certificate)
When submitting the forms, be sure to include your full name and retiree ID number. Without this information, Employee Benefits will not be able to process your request. Send form and documents to firstname.lastname@example.org.