Divorce/Legal Separation »
    
  • Insurance

    • Action: To remove spouse to medical/dental/vision/optional life insurance/optional AD&D effective the date of of divorce/legal separation.
        Forms »
    Choices Enrollment Form
  • COBRA offered:

    • Action: COBRA plan offered within 2 weeks of notification; 60-day window of opportunity to make election. Coverage will begin on first of month following cancellation of coverage. Self pay premiums for up to 36 months.
        Forms » COBRA Rates

  • Optional Health Care Reimbursement Account

    • Action: To decrease dollar amount of election.
        Forms » Change of Status | Election Form & Compensation Reduction Agreement (In office pick-up)

  • Optional Dependent Care Reimbursement Account

    • Action: Can initiate account or increase dollar amount of election for daycare. Consult Benefits Specialist
        Forms » Change of Status | Election Form & Compensation Reduction Agreement (In office pick-up)

  • Taxes

    • Action: Change number of exemptions.
        Forms » W4

  • Beneficiary Changes

    • Action:You may wish to reassign beneficiary status for the following:
        Basic Life/AD&D » use the reverse side of the Choices Enrollment Form.

        Retirement »
    TRS
    PERS Enrollment Card (In office pick-up)
    TIAACREF
        Final Salary Payout »
    Decedent's Warrant
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