For events such as marriage, new children, domestic partnership declaration/terminations, divorces or student status changes, employees must themselves complete the Enrollment or Benefit Change forms and return them to the Benefits Office within 30 days of the event. If you miss this 30 day initial enrollment period you will have to wait for open enrollment.
Open enrollment for all employees to make plan changes runs from May 1st - June 15th of each year. Changes made during open enrollment become effective July 1st of each year.
Please note: When completing any of the Enrollment or Benefit Change forms you must also submit the following:
1) When adding a spouse to your coverage we will need a copy of the Marriage Certificate.
2) In the event of a divorce to remove a spouse from your coverage we will need a copy of the Divorce Decree.
3) When adding a child to your coverage we will need a copy of the Birth Certificate.
Employee Information Change Form
American Fidelity
Section 125 Reimbursment
Blue Shield
Change Form
Enrollment
Domestic Partner Form
Student Certification Form
Prime Mail New Prescription Order Form
Delta Dental PPO
Enrollment / Change Form
Kaiser
Enrollment / Change Form
Disabled Dependent Enrollment Application
Domestic Partner Form
Student Certification Form
Medical Eye Services
Enrollment / Change Form
Claim Form
DeltaCare USA HMO
Enrollment/Change Form
Disability Insurance Claim Forms
American Fidelity
Colonial Life & Accident
