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Mid-Year Change Instructions

Unlike other benefit enrollment activity, you may not make mid-year benefit changes online.

1. Fill out a benefits enrollment change form
Use this form to enroll, change, or cancel benefits for yourself and/or your eligible family members. Be sure to complete all areas of the form and submit supporting documents with your completed form. You may only change certain benefits based on your qualifying event.

Print the Benefits Enrollment/Change and Instructions Form
2. Unless you indicate otherwise on the Benefits Enrollment/Change Form, your current elections will remain in effect through the end of this year.


You have 30 days from the date of your qualifying event or employment status change to complete and submit benefit changes to Human Resources. Any changes requested beyond 30 days cannot be made until the next annual Open Enrollment period.


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