You have thirty days from the date of loss/gain of other coverage to make changes to the appropriate benefits impacted by the qualifying event. Forms must be completed and submitted to HR via fax: (608) 263-5778 or attached to an Ask HR case in ServiceNow.
If you do not make these changes within the 30-day deadline, you must wait until the next available Open Enrollment period to make changes to your benefits enrollment with the changes effective on January 1.
Health and Uniform Dental Insurance
If you wish to change your current medical elections (newly enroll as a result of loss of other coverage or cancel current coverage as a result of gain of other coverage), you will need to submit a health insurance enrollment form to Human Resources.
If you have lost comparable supplemental dental and vision insurance, you would be eligible to pick up coverage as a result of this qualifying event. If you did not lose comparable coverage, review the information for each benefit for other enrollment opportunities.
In addition, you must also submit proof of gain/loss of other coverage to Human Resources. The proof must include the required items listed below and be printed on company letterhead.
- Name of insurer (i.e., insurance company name)
- Name of subscriber (name of plan holder)
- Name(s) of insured (i.e., dependents on the plan)
- Date of termination of coverage
- Reason for termination of coverage
- Subscriber ID number or a copy of insurance card associated with gain or lost coverage
If newly enrolling, coverage through UWHC will begin the first day of loss. If gaining new coverage, therefore canceling current coverage through UWHC, your current coverage will terminate on the effective date of your new plan coverage. If your new coverage is effective on the first of the month, coverage through UWHC will terminate end of the prior month.
The enrollment form and proof needs to be completed and submitted to Human Resources within 30 days of the gain/loss of other coverage date.
Flexible Spending Account
If you wish to update your enrollment with our flexible spending plan due to a qualifying event (gain or loss of coverage), please submit the following form to Human Resources within 30 days of the qualifying event date.