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Mid-Year Benefits Change Instructions

If you've experienced a change in employment status or qualifying life event, you have 30-days from the event date to make certain changes to your benefits.

1) Print and complete a Benefits Enrollment/Change Form.  
Use this form to enroll, change, or cancel benefits for yourself and/or your eligible family members. Indicate the requested changes only; all other existing benefits will remain the same. 

2) Submit your completed form to the Benefits Department by mail or fax as specified on the form. Be sure to submit any necessary supporting documents as specified. You may only change certain benefits based on your qualifying event (see Benefits Enrollment/Change form for details).


You have 30 days from the date of your employment status change or qualifying event to submit requested 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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