Active Enrollment Change Form-Birth of a Child (Required documents & steps)

This is a document designed for active employees who have life-events and need to make changes to the enrollments. 

Life Event Type and Required Documentation

Birth of a Child:

-Birth Certificate (mother’s copy)

-Social Security Card (if not available, submit when it arrives; be advised we must have the social security card on file)

Steps to Start Life Event Process 

1. Please complete the enrollment change form listed below and submit the form along with the above documents to the Benefits Department via the [e-mail] email address.
 

-Enrollment Change Form- 

https://na3.docusign.net/Member/PowerFormSigning.aspx?PowerFormId=0c0bf311-c02b-4cb1-acba-3a37930c6388&env=na3&acct=19cbdccc-227e-46af-a46c-0559a3cca114&v=2m