Get Change In Status Form For Mid-year Benefit Election Changes

This guide provides a clear and comprehensive walkthrough for filling out the Change In Status Form For Mid-year Benefit Election Changes online. Understanding the form and its components is essential for making timely and valid changes to your employee benefit elections.

Follow the steps to complete your Change In Status Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Review the eligibility criteria for submitting the form. Ensure that your request aligns with one of the Change in Status events listed.
3. In Section I, identify and check all applicable Change in Status events that have occurred. Next to each event, provide the date in the format mm/dd/yyyy.
4. Move to Section II to indicate the specific benefit plan changes you wish to request. Check each relevant option under health benefits, life insurance, dental, vision, long-term disability, long-term care, and UT FLEX.
5. Carefully read the important statement regarding documentation requirements. Confirm that you understand the need for appropriate documentation relating to the changes requested.
6. Sign the form in the designated area, ensuring your signature is clear, and print your name next to it. Include the date you signed in mm/dd/yyyy format.
7. Once you have completed the form, save the changes and download it. You may print it for your records and to submit it to your benefits office.

Start completing your Change In Status Form online today to ensure your benefit changes are processed in a timely manner.