Changing Medical/Dental Enrollment
for Faculty, Staff & Librarians
Special Open Enrollment - Court Order or Medical Support Enforcement
For coverage of a dependent or a subscriber's spouse or qualified domestic partner
| Options |
Actions |
| If you previously waived medical coverage, you must: |
-
Enroll yourself in medical to add your newly eligible dependent(s) to medical and/or dental.
|
Within 60 days of the court order, submit this form and supporting documents to the Benefits Office:
- Employee Enrollment/Change Form
- Supporting Documents:
- Any necessary dependent certifications.
- A copy of the court order or medical support enforcement.
- In addition, you may enroll, change, or cancel your participation in either of these tax-savings programs. Enrollment is optional.
|
| If you are currently enrolled in medical and dental coverage , you can: |
- Enroll newly eligible dependent(s) in medical and/or dental.
- Change your medical and/or dental plan provided you enroll your newly eligible dependent.
|
Within 60 days of the court order, submit this form and supporting documents to the Benefits Office:
- Employee Enrollment/Change Form
- Supporting Documents:
- Any necessary dependent certifications.
- A copy of the court order or medical support enforcement.
- In addition, you may enroll, change, or cancel your participation in either of these tax-savings programs. Enrollment is optional.
|
| Coverage Begins |
- Coverage and/or plan change begins on the first day of the month following the change in status.
Unless the change in status occurs on the first day of the month, then coverage and/or plan change begin on that day.
|
More information:
Flexible Spending Account
Dependent Care Assistance Program
Adding a Child to Medical/Dental Insurance |
Disclaimer: This "qualifying life event series" highlights benefit options arising from a change in family status. It does not substitute for official plan documents. If there is a conflict between the information on this site and an official plan document, the official plan document will govern. Plan availability and eligibility may change depending on your employment status and/or actions of the Washington State Health Care Authority.
Changing Enrollment—
Qualifying Life Events
