What Constitutes a Qualifying Life Event?
Benefits Allowed to Change
Qualifying Life Event
Documentation
Change in marital status: ∙ Marriage ∙ Divorce or Annulment ∙ Legal Separation ∙ Domestic Partner Dissolution ∙ Death of Spouse
Marriage Certificate Divorce Decree Final Court Document Notarized Statement of Disenrollment Death Certificate
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Change in the number of dependents: ∙ Birth ∙ Adoption
Birth Certificate, Hospital Announcement Adoption Agreement Court Decree for Guardianship Death Certificate Provide Name, Social Security Number, and Date of Birth for dependents Proof of Loss of Coverage, such as termination letter; Certificate of Creditable Coverage
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∙ Guardianship of a Child ∙ Death of a Dependent
Dependent Becomes Eligible
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Dependent Loses Other Coverage
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Proof of Coverage with start date of benefits and name(s) of covered dependents
Dependent Gains Other Coverage
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A change in Employee's, spouse's, or dependent's work hours (including a switch between full and part-time status)
Proof of loss of Coverage due to employment status change, such as a Certificate of Creditable Coverage or letter from the company
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Change in Dependent Care Costs
Letter from your Day Care Provider
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Court Ordered Dependent, add or drop from coverage
Contact your Benefits Team Directly
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For more information on Qualifying Events scan the QR code with your mobile device.
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