Changing Medical/Dental Enrollment
for Faculty, Staff & Librarians

• You must enroll yourself in medical to add your new child to medical and/or dental.
• You may enroll your spouse/QDP in medical and/or dental provided you enroll the new child.

Within 60 days of assuming legal obligation for support in anticipation of the adoption, even if adding your new child does not increase the premium, submit this form and supporting document to the Benefits Office:

• Employee Enrollment/Change Form
• Supporting Document: Copy of adoption papers
• In addition, you may enroll, change, or cancel your participation in either of these tax-savings programs. Enrollment is optional.
  • Flexible Spending Account
  • Dependent Care Assistance Program

• Enroll your new child in medical and/or dental.
• Enroll your spouse/QDP in medical and/or dental provided you enroll the new child.
• Change your medical and/or dental plan provided you enroll your new child.
• Waive medical for yourself, and medical and/or dental for your eligible dependents, provided that they have other comprehensive group coverage.

• Within 60 days of assuming legal obligation for support in anticipation of the adoption, even if adding your new child does not increase your premiums, submit these forms and supporting document to the Benefits Office:
• Employee Enrollment/Change form - note the date of adoption or date you assumed financial responsibility of the child(ren) on this form.
• Spouse or Qualified Domestic Partner Certification form if enrolling a spouse or domestic partner.
• Supporting Document: Copy of adoption papers.
• In addition, you may enroll, change, or cancel your participation in either of these tax-savings programs. Enrollment is optional.
  • Flexible Spending Account
  • Dependent Care Assistance Program

• New Child: Coverage begins on the date that you assume legal obligation in anticipation of the adoption.
• Spouse: Coverage begins on the first day of the month you assume legal obligation.**
• Plan Change: New plan coverage begins the first day of the month in which you assume legal obligation.**
  
  **The employee has the option to request the coverage begin on the first of the month following the adoption of the child. Indicate this directly on the Employee Enrollment/Change Form or attach a separate note to the form.