Update Your Information

• Change Form
  If you enroll by paper, use this form to correct any errors currently appearing in your personal information, update your name and marital status, change your coverage type and add or remove dependents from your policy.
• Employee Self Service Instructions for BEACON
  If you enroll through the BEACON system, this form provides instructions on how to make changes to your coverage.
• Instructions for Making Your Benefit Changes Online for Benefitfocus^TM
  If you enroll through the eBenefitsNow system, this form provides instructions on how to make changes to your coverage.
• Certification of Dependent Eligibility
  Use this form if you are adding a foster child.
• Coverage Request for Incapacitated Dependent
  Use this form if you are adding a child over age 19 who is eligible as a mentally or physically incapacitated dependent.
• Prior Health Coverage Information
  If you had coverage under a previous plan, perhaps from a previous employer, use this form to receive credit against the waiting period for pre-existing conditions.
• Retiree Instructions for Completing Life Event Changes Online
  This form provides instructions on how to make changes to your coverage through the eBenefitsNow system.
• Leave of Absence Form for Non-BEACON Agencies
  If you are an employee with a Non-BEACON agency, this form provides options for health benefits while on a leave of absence.

Please print out the appropriate forms above and give the completed forms to your Health Benefits Representative/benefits office for processing.

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