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Changing Medical/Dental Enrollment
for Faculty, Staff & Librarians

Special Open Enrollment - Death of a Family Member

Terminating a dependent's coverage due to death.

Options Actions
If you previously waived medical coverage, you may:

Enroll yourself in medical to add eligible family member(s) in medical and dental coverage.

Within 60 days of the event submit this form to the Benefits Office:

If you are already enrolled:

You must:

  • Remove the decedent's name from your plan so that:
    • You will not be billed for claims paid by the health plan for services after the date of death.
    • You will not be responsible for premiums paid by the employee/employer for the dependent's health plan enrollment after the date of death.

You can:

  • Change your medical and/or dental plan.

Within 60 days of the event submit this form to the Benefits Office:

Coverage
  • Coverage or Plan Change: Begins the first day of the month following the dependent's loss of eligibility
  • Decedent : Enrollment ends the last day of the month in which the death occurred.

More information:

UW CareLink - Faculty and Staff Assistance Program

Flexible Spending Account

Dependent Care Assistance Program

Life Insurance Beneficiary Designation/Change Form

DRS Retirement Plan Beneficiary/Change Form

UWRP Beneficiary Designation/Change - Contact your fund sponsor(s) for the appropriate form.

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