Changing Medical/Dental Enrollment
for Faculty, Staff & Librarians

• You must enroll yourself in medical insurance if you do not have other group medical insurance coverage.
• You must enroll yourself in medical insurance to add eligible dependent(s) in medical coverage.

Within 60 days of the loss of health insurance coverage, submit these forms to the Benefits Office:

• Employee Enrollment/Change Form
• Any required dependent certification forms
• Valid dependent verification documents.
• Proof of Loss Statement from the insurance company or a letter from previous employer indicating date of loss and family members that were covered.

• You may enroll your eligible dependent(s) in medical and/or dental insurance.
• You may change your medical and/or dental plan only if you are also enrolling your eligible dependent in the plan.

Within 60 days of the loss of coverage, submit these forms to the Benefits Office:

• Employee Enrollment/Change Form
• Any required dependent certification forms
• Valid dependent verification documents.
• Proof of Loss Statement from the insurance company or a letter from previous employer indicating date of loss and family members that were covered.

• Coverage and/or plan change begins on the first day of the month following the loss of health insurance coverage unless the loss of coverage occurs on the first day of the month, then coverage and/or plan change begin on that day.

• 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