You have 30 days from the date of birth or adoption to add your dependent to your insurance. Forms must be completed and submitted to HR via fax: (608) 263-5778 or by attaching to an Ask HR case in ServiceNow.
If you do not enroll your new dependent within the 30-day deadline, you must wait until the next available Open Enrollment period to make changes to your benefits enrollments and the change will be effective on January 1.
If you wish to enroll or add a dependent to your health insurance as a result of the birth or adoption of a child, you will need to submit a completed health insurance application/change form.
- Unity Health Insurance Application
- More information on Health Insurance, including premiums, coverage, etc.
Please Note: It can take several weeks to receive a newborn's social security card. Please submit your application without your newborn's social security number and follow up with Human Resources once you have received their social security number.
This form must be completed and receive to Human Resources within 30 days of the qualifying event date. Medical enrollment is effective the date of birth or adoption.
If you wish to cancel your current medical coverage, you must gain new coverage. Please see the Life Events: Loss or Gain of Other Coverage page.
If you wish to change your current dental election (newly enroll, add/drop dependent(s), or cancel), you will need to submit a dental insurance enrollment form.
- Dental Insurance Enrollment Form
- More information on Dental Insurance, including premiums, coverage, etc.
This form needs to be completed and submitted to HR within 30 days of your date of the birth or adoption. Dental enrollment is effective the date of birth or adoption.
If you wish to cancel your current dental coverage, you must gain new coverage. Please see the Life Events: Gain or Loss of Other Coverage page.
There are other benefits an employee can change due to a qualifying life event. Below is a list of benefits an employee could change if eligible for the benefits. Refer to Employee Self Service to review your benefit eligibility. If interested in changing, please complete the appropriate form.
|More Information||Enrollment Form|
|Supplemental Life||Supplemental Life Enrollment Form|
|Dependent Life||Dependent Life Enrollment Form|
|Flexible Spending Account||FSA Status Change Form|
|LifeLock||LifeLock Enrollment Form|
If you wish to change your beneficiary for your life insurance(s) and/or retirement plan, you will need to complete the required beneficiary forms.
Please note: In the State of Wisconsin, your spouse must be listed as your 100% primary beneficiary, unless you submit a notarized spousal consent form.