Update Your Information

• Change Form (PDF, 90KB)
  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 (PDF, 52KB)
  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 (PDF, 333 KB)
  If you enroll through the eBenefitsNow system, this form provides instructions on how to make changes to your coverage.
  
  
• Certification of Dependent Eligibility (PDF, 117KB)
  Use this form if you are adding a foster child.
  
  
• Coverage Request for Incapacitated Dependent (PDF, 204KB)
  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 (PDF, 183KB)
  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.

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