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Changing Medical/Dental Enrollment
for Faculty, Staff & Librarians

Special Open Enrollment - Divorce, Annulment, Legal Separation, or Dissolution of a Qualified Domestic Partnership

Options Actions
If you previously waived medical coverage, you may:
  • Enroll yourself in medical.

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

  • Employee Enrollment/Change Form
  • Supporting Document:
    Copy of court order for divorce, annulment, legal separation, or dissolution (if part of the Secretary of State registry)
  • Be sure to check your life insurance coverage and retirement plan to make sure your beneficiary designations are current.
  • In addition, you may enroll, change, or cancel your participation in either of these tax-savings programs. Enrollment is optional.
If you are already enrolled, you must:

Remove a former spouse or former qualified domestic partner when a divorce, or termination of a domestic partnership is finalized, even if a court order requires that you provide health insurance for the former spouse or partner. Consequences for not removing the former spouse or partner's coverage may include:

  • Dependent's loss of eligibility to continue enrollment under one of the continuation options (i.e. COBRA)
  • Subscriber may be billed for claims paid by the health plan for services after the dependent lost eligibility
  • Subscriber is responsible for premiums paid by the employer for the dependent's health plan enrollment after the dependent lost eligibility.

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

  • Employee Enrollment/Change Form
  • Supporting Document:
    Copy of court order for divorce, annulment, legal separation, or dissolution (if part of the Secretary of State registry)
  • Be sure to check your life insurance coverage and retirement plan to make sure your beneficiary designations are current.
  • In addition, you may enroll, change, or cancel your participation in either of these tax-savings programs. Enrollment is optional.
Coverage Begins
  • Coverage or Plan Change: Begins the first day of the month following the dependent's loss of eligibility
  • Ineligible Dependent : Enrollment ends the last day of the month in which they are no longer eligible

More information:

Flexible Spending Account

Dependent Care Assistance Program

COBRA (Continuing Insurance)

Loss of Coverage

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