Benefit Changes

Use the links below to update your benefits when you’ve had a change that will impact your benefits.

Marriage/Domestic Parntership • Newborn/Adoption • New Dependent with Disability/Extended Dependent
Divorce • Death • Other Changes

Marriage/Domestic Partnership

Update your Medical and Dental Plans

2017 Medical and Dental Change form: Use this forms to enroll newly acquired dependents* (e.g. new marriage/domestic partnership) within 60 days of becoming eligible.  This form is also used to update name and address changes, and to terminate coverage for dependents who are no longer eligible.  View the Dependent Eligibility Worksheet for more information.

* You must also submit valid dependent verification documents in order to add new dependents to your medical and/or dental plan.

Update your Flexible Spending Account/Dependent Care Assistance Program

2017 FSA & DCAP Enrollment/Change Form – Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the marriage/domestic partnership.

2017 FSA & DCAP Change of Status Form – Use this form to increase in your FSA and/or DCAP within 60 days of the marriage/domestic partnership

The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).

Update your Health Savings Account

Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts

Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.

Health Savings Account Name Change: Contact Health Equity (account administrator) at 1.877.873.8823 to update your name. Updating your name through the WSU processes identified below will NOT update your Health Savings Account. Employees must contact Health Equity for this update.

Update your Life Insurance

Life Insurance Enrollment & Change Form:  Use this form to request additional coverage for yourself or a new family member.

Beneficiary Designation:  Use this form to update your beneficiary designations.

Update your Retirement and Voluntary Retirement Plans

WSURP and/or VIP Beneficiary Changes: Update beneficiaries online.

WSURP and/or VIP Name Change Form:  Use this form to update your name. Updating your name through the WSU processes identified below will NOT update your WSURP or VIP accounts. Employees must complete this form to  update their name.

DRS and/or DCP Beneficiary Designation Form:  Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations.  You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.

DRS and/or DCP Name & Address Change Form:  To be completed by inactive members, retirees and beneficiaries receiving benefits.  Active members will have these accounts updated when they update their names/addresses through the WSU process, identified below.

Update Washington State University

WSU Name Changes:  Official name changes with Washington State University.

WSU Address Changes:  Official address changes with Washington State University.

Newborn/Adoption/New Dependent with Disability or Extended Dependent

Update your Medical and Dental Plans

2017 Medical and Dental Change form: Use this form to enroll newly acquired dependents* (e.g. newborn**, adoption) as soon as possible.  This form is also used to terminate coverage for dependents who are no longer eligible.  View the Dependent Eligibility Worksheet for more information.  Additionally, dependents with disabilities and/or extended dependents may also be enrolled under an employee’s coverage.  See the Dependents with Disabilities and Extended Dependents Worksheet for more information.

* You must also submit valid dependent verification documents in order to add new dependents to your medical and/or dental plan.

** The initial three weeks of coverage for newborns is automatic and reported to health carriers by the hospital.   

Update your Flexible Spending Account/Dependent Care Assistance Program

2017 FSA & DCAP Enrollment/Change Form – Use this form to initiate enrollment into an FSA or DCAP within 60 days of the birth/adoption/assumed legal obligation.

2017 FSA & DCAP Change of Status Form – Use this form to request an increase in your FSA and/or DCAP within 60 days of the birth/adoption/assumed legal obligation

The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services).

Update your Health Savings Account

Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts

Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.

Update your Life Insurance

Life Insurance Enrollment & Change Form:  Use this form to request additional coverage for yourself or a new family member.

Beneficiary Designation:  Use this form to update your beneficiary designations.

Update your Retirement and Voluntary Retirement Plans

WSURP and/or VIP Beneficiary Changes: Update beneficiaries online.

DRS and/or DCP Beneficiary Designation Form:  Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations.  You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.

Divorce

Update your Medical and Dental Plans

2017 Medical and Dental Change form: Use this form to terminate coverage for dependents who are no longer eligible within 60 days of the event.  View the Dependent Eligibility Worksheet for more information.

Update your Flexible Spending Account/Dependent Care Assistance Program

2017 FSA & DCAP Enrollment/Change Form – Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the dissolution.

2017 FSA & DCAP Change of Status Form – Use this form to request a decrease in your FSA and/or DCAP within 60 days of the dissolution

The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).

Update your Health Savings Account

Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts

Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.

Health Savings Account Name Change: Contact Health Equity (account administrator) at 1.877.873.8823 to update your name. Updating your name through the WSU processes identified below will NOT update your Health Savings Account. Employees must contact Health Equity for this update.

Update your Life Insurance

Life Insurance Enrollment & Change Form:  Use this form to request additional coverage for yourself or a new family member.

Beneficiary Designation:  Use this form to update your beneficiary designations.

Update your Retirement and Voluntary Retirement Plans

WSURP and/or VIP Beneficiary Changes: Update beneficiaries online.

WSURP and/or VIP Name Change Form:  Use this form to update your name. Updating your name through the WSU processes identified below will NOT update your WSURP or VIP accounts. Employees must complete this form to  update their name.

DRS and/or DCP Beneficiary Designation Form:  Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations.  You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.

DRS and/or DCP Name & Address Change Form:  To be completed by inactive members, retirees and beneficiaries receiving benefits.  Active members will have these accounts updated when they update their names/addresses through the WSU process, identified below.

Update Washington State University

WSU Name Changes:  Official name changes with Washington State University.

WSU Address Changes:  Official address changes with Washington State University.

Death

Update your Medical and Dental Plans

2017 Medical and Dental Change form: Use this form to terminate coverage for dependents who are no longer eligible within 60 days of the event.  View the Dependent Eligibility Worksheet for more information.

Update your Flexible Spending Account/Dependent Care Assistance Program

2017 FSA & DCAP Enrollment/Change Form – Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the death.

2017 FSA & DCAP Change of Status Form – Use this form to request a decrease in your FSA and/or DCAP within 60 days of the death

The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).

Update your Health Savings Account

Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts

Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.

Update your Life Insurance

Life Insurance Enrollment & Change Form: Use this form to request additional coverage for yourself or a new family member.

Beneficiary Designation:  Use this form to update your beneficiary designations.

Update your Retirement and Voluntary Retirement Plans

WSURP and/or VIP Beneficiary Changes: Update beneficiaries online.

DRS and/or DCP Beneficiary Designation Form:  Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations.  You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.

Other Changes

Update your Medical and Dental Plans

2017 Medical and Dental Change form: Use this form to enroll newly acquired dependents* within 60 days of becoming eligible.  This form is also used to update name and address changes, and to terminate coverage for dependents who are no longer eligible within 60 days of the event.  View the Dependent Eligibility Worksheet for more information.  Additionally, dependents with disabilities and/or extended dependents may also be enrolled under an employee’s coverage.  See the Dependents with Disabilities and Extended Dependents Worksheet for more information.

* You must also submit valid dependent verification documents in order to add new dependents to your medical and/or dental plan.

** The initial three weeks of coverage for newborns is automatic and reported to health carriers by the hospital.  However, employees still have 60 days to enroll newborns permanently.

2017 Premium Surcharge Change Form

Use this form to update the tobacco status for yourself or a covered family member, or to update the status of coverage available to your spouse/registered domestic partner’s healthcare coverage available through their employer.

Update your Flexible Spending Account/Dependent Care Assistance Program

2017 FSA & DCAP Enrollment/Change Form – Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the qualifying event.

2017 FSA & DCAP Change of Status Form – Use this form to request a change in your FSA and/or DCAP within 60 days of the qualifying event

The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).

Update your Health Savings Account

Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts

Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.

Health Savings Account Name Change: Contact Health Equity (account administrator) at 1.877.873.8823 to update your name. Updating your name through the WSU processes identified below will NOT update your Health Savings Account. Employees must contact Health Equity for this update.

Update your Life Insurance

Life Insurance Enrollment & Change Form:  Use this form to request additional coverage for yourself or a new family member.

Beneficiary Designation:  Use this form to update your beneficiary designations.

Update your Retirement and Voluntary Retirement Plans

WSURP and/or VIP Beneficiary Changes: Update beneficiaries online.

WSURP and/or VIP Name Change Form:  Use this form to update your name. Updating your name through the WSU processes identified below will NOT update your WSURP or VIP accounts. Employees must complete this form to  update their name.

DRS and/or DCP Beneficiary Designation Form:  Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations.  You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.

DRS and/or DCP Name & Address Change Form:  To be completed by inactive members, retirees and beneficiaries receiving benefits.  Active members will have these accounts updated when they update their names/addresses through the WSU process, identified below.

Update Washington State University

WSU Name Changes:  Official name changes with Washington State University.

WSU Address Changes:  Official address changes with Washington State University.

Washington State University