Use the links below to update your benefits when you've had a change in dependent/family status including marriage, adoption, newborn, divorce, and other changes.
Marriage/Domestic Partnership
Update your Medical and Dental Plans
2016 Medical and Dental Change form
Use this forms to enroll newly acquired dependents* (e.g. new marriage/domestic partnership) within 60 days of becoming eligible. This form is also used to update name and address changes, and to terminate coverage for dependents who are no longer eligible. View the Dependent Eligibility Worksheet for more information.
* You must also submit valid dependent verification documents in order to add new dependents to your medical and/or dental plan.
Update your Flexible Spending Account/Dependent Care Assistance Program
2016 FSA & DCAP Enrollment/Change Form - Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the marriage/domestic partnership.
2016 FSA & DCAP Change of Status Form - Use this form to increase in your FSA and/or DCAP within 60 days of the marriage/domestic partnership.
The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).
Update your Health Savings Account
Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts
Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.
Health Savings Account Name Change: Contact Health Equity (account administrator) at 1.877.873.8823 to update your name. Updating your name through the WSU processes identified below will NOT update your Health Savings Account. Employees must contact Health Equity for this update.
Update your Life Insurance
Life Insurance Enrollment & Change Form: Use this form to request additional coverage for yourself or a new family member.
Beneficiary Designation: Use this form to update your beneficiary designations.
Update your Retirement and Voluntary Retirement Plans
WSURP and/or VIP Beneficiary Changes: Update beneficiaries online or use the paper form.
WSURP and/or VIP Name Change Form: Use this form to update your name. Updating your name through the WSU processes identified below will NOT update your WSURP or VIP accounts. Employees must complete this form to update their name.
DRS and/or DCP Beneficiary Designation Form: Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations. You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.
DRS and/or DCP Name & Address Change Form: To be completed by inactive members, retirees and beneficiaries receiving benefits. Active members will have these accounts updated when they update their names/addresses through the WSU process, identified below.
Update Washington State University
WSU Name Changes: Official name changes with Washington State University.
WSU Address Changes: Official address changes with Washington State University.
Newborn/Adoption/New Dependent with Disability or Extended Dependent
Update your Medical and Dental Plans
2016 Medical and Dental Change form
Use this form to enroll newly acquired dependents* (e.g. newborn**, adoption) as soon as possible. This form is also used to terminate coverage for dependents who are no longer eligible. View the Dependent Eligibility Worksheet for more information. Additionally, dependents with disabilities and/or extended dependents may also be enrolled under an employee's coverage. See the Dependents with Disabilities and Extended Dependents Worksheet for more information.
* You must also submit valid dependent verification documents in order to add new dependents to your medical and/or dental plan.
** The initial three weeks of coverage for newborns is automatic and reported to health carriers by the hospital.
Update your Flexible Spending Account/Dependent Care Assistance Program
2016 FSA & DCAP Enrollment/Change Form - Use this form to initiate enrollment into an FSA or DCAP within 60 days of the birth/adoption/assumed legal obligation.
2016 FSA & DCAP Change of Status Form - Use this form to request an increase in your FSA and/or DCAP within 60 days of the birth/adoption/assumed legal obligation.
The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services).
Update your Health Savings Account
Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts
Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.
Update your Life Insurance
Life Insurance Enrollment & Change Form: Use this form to request additional coverage for yourself or a new family member.
Beneficiary Designation: Use this form to update your beneficiary designations.
Update your Retirement and Voluntary Retirement Plans
WSURP and/or VIP Beneficiary Changes: Update beneficiaries online or use the paper form.
DRS and/or DCP Beneficiary Designation Form: Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations. You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.
Update your Medical and Dental Plans
2016 Medical and Dental Change form
Use this form to terminate coverage for dependents who are no longer eligible within 60 days of the event. View the Dependent Eligibility Worksheet for more information.
Update your Flexible Spending Account/Dependent Care Assistance Program
2016 FSA & DCAP Enrollment/Change Form - Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the dissolution.
2016 FSA & DCAP Change of Status Form - Use this form to request a decrease in your FSA and/or DCAP within 60 days of the dissolution.
The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).
Update your Health Savings Account
Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts
Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.
Health Savings Account Name Change: Contact Health Equity (account administrator) at 1.877.873.8823 to update your name. Updating your name through the WSU processes identified below will NOT update your Health Savings Account. Employees must contact Health Equity for this update.
Update your Life Insurance
Life Insurance Enrollment & Change Form: Use this form to request additional coverage for yourself or a new family member.
Beneficiary Designation: Use this form to update your beneficiary designations.
Update your Retirement and Voluntary Retirement Plans
WSURP and/or VIP Beneficiary Changes: Update beneficiaries online or use the paper form.
WSURP and/or VIP Name Change Form: Use this form to update your name. Updating your name through the WSU processes identified below will NOT update your WSURP or VIP accounts. Employees must complete this form to update their name.
DRS and/or DCP Beneficiary Designation Form: Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations. You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.
DRS and/or DCP Name & Address Change Form: To be completed by inactive members, retirees and beneficiaries receiving benefits. Active members will have these accounts updated when they update their names/addresses through the WSU process, identified below.
Update Washington State University
WSU Name Changes: Official name changes with Washington State University.
WSU Address Changes: Official address changes with Washington State University.
Update your Medical and Dental Plans
2016 Medical and Dental Change form
Use this form to terminate coverage for dependents who are no longer eligible within 60 days of the event. View the Dependent Eligibility Worksheet for more information.
Update your Flexible Spending Account/Dependent Care Assistance Program
2016 FSA & DCAP Enrollment/Change Form - Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the death.
2016 FSA & DCAP Change of Status Form - Use this form to request a decrease in your FSA and/or DCAP within 60 days of the death.
The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).
Update your Health Savings Account
Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts
Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.
Update your Life Insurance
Life Insurance Enrollment & Change Form: Use this form to request additional coverage for yourself or a new family member.
Beneficiary Designation: Use this form to update your beneficiary designations.
Update your Retirement and Voluntary Retirement Plans
WSURP and/or VIP Beneficiary Changes: Update beneficiaries online or use the paper form.
DRS and/or DCP Beneficiary Designation Form: Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations. You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.
Update your Medical and Dental Plans
2016 Medical and Dental Change form
Use this form to enroll newly acquired dependents* within 60 days of becoming eligible. This form is also used to update name and address changes, and to terminate coverage for dependents who are no longer eligible within 60 days of the event. View the Dependent Eligibility Worksheet for more information. Additionally, dependents with disabilities and/or extended dependents may also be enrolled under an employee's coverage. See the Dependents with Disabilities and Extended Dependents Worksheet for more information.
* You must also submit valid dependent verification documents in order to add new dependents to your medical and/or dental plan.
** The initial three weeks of coverage for newborns is automatic and reported to health carriers by the hospital. However, employees still have 60 days to enroll newborns permanently.
2016 Premium Surcharge Change Form
Use this form to update the tobacco status for yourself or a covered family member, or to update the status of coverage available to your spouse/registered domestic partner's healthcare coverage available through their employer.
Update your Flexible Spending Account/Dependent Care Assistance Program
2016 FSA & DCAP Enrollment/Change Form - Use this form to initiate enrollment in to an FSA and/or DCAP within 60 days of the qualifying event.
2016 FSA & DCAP Change of Status Form - Use this form to request a change in your FSA and/or DCAP within 60 days of the qualifying event.
The requested change must correspond to the event that creates the special open enrollment and changes are effective the first of the month following approval of the change from Navia Benefit Solutions (formerly Flex-Plan Services, Inc.).
Update your Health Savings Account
Employee Authorization for Payroll Deduction to HSA: Use this form to enroll or change your HSA contribution amounts
Health Savings Account Beneficiary Designation Form: Use this form to update your beneficiary designations.
Health Savings Account Name Change: Contact Health Equity (account administrator) at 1.877.873.8823 to update your name. Updating your name through the WSU processes identified below will NOT update your Health Savings Account. Employees must contact Health Equity for this update.
Update your Life Insurance
Life Insurance Enrollment & Change Form: Use this form to request additional coverage for yourself or a new family member.
Beneficiary Designation: Use this form to update your beneficiary designations.
Update your Retirement and Voluntary Retirement Plans
WSURP and/or VIP Beneficiary Changes: Update beneficiaries online or use the paper form.
WSURP and/or VIP Name Change Form: Use this form to update your name. Updating your name through the WSU processes identified below will NOT update your WSURP or VIP accounts. Employees must complete this form to update their name.
DRS and/or DCP Beneficiary Designation Form: Use this form to update your PERS, TRS, LEOFF and/or DCP beneficiary designations. You may be able to view your current beneficiaries via the Department of Retirement Systems (DRS) website, under Your Retirement Account.
DRS and/or DCP Name & Address Change Form: To be completed by inactive members, retirees and beneficiaries receiving benefits. Active members will have these accounts updated when they update their names/addresses through the WSU process, identified below.
Update Washington State University
WSU Name Changes: Official name changes with Washington State University.
WSU Address Changes: Official address changes with Washington State University.
