Update your Medical and Dental Plans

2020 Employee Enrollment 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

2020 FSA & DCAP Enrollment Form: Use this form to initiate enrollment into an FSA or DCAP within 60 days of the birth/adoption/assumed legal obligation.

2019 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

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.