Making changes to your health plan:

Please keep in mind that enrollment in and changes to health insurance are only allowed during the annual open enrollment period (in October each year) or within 30 days of a qualifying family status change.

Where to send the forms:

Claim forms should be send directly to the address listed on the form.

Enrollment, change, and certification of dependent status forms, when completed, should be sent to the benefits staff within Human Resources. 

 Qualifying Status Change form  
 Coordination of Benefits Form   (for dual coverage)
 Certification of Dependent Status   (child dependents age 19-25)
 HRA Reimbursement Claim Form  
 HSA Distribution Request Form  
 Regular claim form   (for covered services initially paid out of pocket)
 Wells Fargo Enrollment for HSA Plan  
 Beneficiary Designation for HSA Acct   (for use with the HSA plan)