Update your Medical and Dental Plans

2020 Employee Enrollment 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

2020 FSA & DCAP Enrollment Form – Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the death.

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

2020 Employee Authorization for Payroll Deduction to HSA Form: 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.