• Family Status Change

    The plan options and coverage levels you select during the annual open enrollment period will remain in effect from September 1 - August 31. You cannot add or change covered persons during the year unless you have a qualified Family Status Change/Special Enrollment Event. All documents must be received by the Benefits Office within 31 days of qualifying event date.

    Enrollment Application & Change Form


    What is a qualified Family Status Change/Special Enrollment Event?

    • Marriage
    • Divorce
    • Birth, adoption or placement for adoption
    • Death
    • Cessation of dependent status (such as attaining the age limit)
    • Termination of employment
    • Spouse gains or loses employment
    • Loss of coverage under a group plan
    • COBRA coverage under another plan has exhausted

    When do I need to have all documents to the Benefits Office?
    Within 31 days of the qualifying event date.

    What benefits can I change?
    All changes must be consistent with the IRS Code 125 cafeteria plan.

    You may add: Medical, dental and vision as allowed by IRS Code Section 125. If adding Voluntary Life and the employee is not currently enrolled, then employee may be required to answer medical questions. In the case of marriage, birth, adoption or placement for adoption, you can elect to increase (but not reduce) the amount of your voluntary life insurance coverage (subject to plan limitations).

    You may drop: All benefits depending on the qualifying event. In the case of divorce or death of a spouse or dependent, you can elect to reduce (but not increase) the amount of your voluntary life insurance coverage.

    What is a Section 125 cafeteria plan?
    A cafeteria plan is an employer-maintained separate written plan for employees that meets the requirements and regulations of Section 125 of the Internal Revenue Code. It provides participants an opportunity to receive certain benefits on a pre-tax basis.

    What pre-tax benefits are covered under the Section 125 cafeteria plan?
    Medical, dental, vision, Accident, Cancer, Critical Illness, FSA and 457/403(b). Please view the Section 125 of the Internal Revenue Code for more details.