Update Your Information

• Change Form (PDF, 90KB)
  Use this form to correct any errors currently appearing in your personal information, update your name and marital status, change your coverage type and add or remove dependents from your policy.
  
  
• Certification of Dependent Eligibility (PDF, 117KB)
  Use this form if you are adding a child whose last name is different from yours.
  
  
• Coverage Request for Incapacitated Dependent (PDF, 204KB)
  Use this form if you are adding a child over age 19 who is eligible as a mentally or physically incapacitated dependent.
  
  
• Prior Health Coverage Information (PDF, 183KB)
  If you had coverage under a previous plan, perhaps from a previous employer, use this form to receive credit against the waiting period for pre-existing conditions.

Please print out the appropriate forms above and give the completed forms to your Health Benefits Representative in your human resources department for processing.