Life Event Changes

Flexible Spending Arrangement - Life Event Changes


Certain events, such as dependent changes, qualify for mid-year plan changes. A mid-year plan change would include signing up for participation outside of open enrollment for proactive expenses associated with a life event change.

Please return all forms to the Human Resources Office.
 Examples of Changes Process to Use 
 Add or remove dependent Life Event Change 
 Name change
 Address change
 Phone change
 Etc.
Termination or commencement of employment by spouse or dependent Employment Change 
Switching from / to part-time employment by employee, spouse, or dependent  
Hours reduction, strike or lockout  
Leaving employment  
Leave-of-absence 
Etc.