Benefits Open Enrollment:
Changes to employee selected optional benefits can only be made when the employee experiences a "Major Life Event" or during "Annual Benefits Open Enrollment". Changes made during the 30 day open enrollment period are effective during the next plan year. Annual Open Enrollment is typically mid-April through Mid-May, and the UA benefit plan year is July 1 - June 30.
Major Life Event:
Review the checklist below to determine if you have experienced a qualifying event and determine what changes you wish to make. The most commonly used forms are provided below. To access all UA benefits forms, click on the A - Z link below. Completed forms must be sent to your regional HR office within 30 days of the event.
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- Major Life Event checklist
- Most Common Changes and Forms:
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- Dependent Health Enrollment/Drop Form
Add/Delete dependent from health coverage - Statement of Financial Interdependency Form, used to
Document a Financially Interdependent Partner (FIP)
relationship and required in addition
to the Dependent Enrollment Form to add a
(FIP) to the health plan - Financial Interdependent Relationship Explanation
- Declaration of Termination of Financial Interdependent Relationship
Document the termination of a Financially Interdependent
Partner (FIP) relationship and required in addition
to the Dependent Enrollment Form to drop a
(FIP) to the health plan - UA Choice Supplemental Benefits Election Form,
Use to change FSA and/or Life Insurance Coverage - Beneficiary Form for TRS/PERS (Defined Benefit Plan)
Use for TRS Tiers I, II, and PERS Tiers I, II, III - Beneficiary Form for TRS/PERS (Defined Contribution Plan)
Use for TRS Tier III and PERS Tier IV - Beneficiary Designation for UA ORP and/or UA Pension
Fidelty Beneficiary Form or call (800) 343-0860
Valic, call (907) 279-8302
TIAA-CREF, call (800) 842-2007
Lincoln National, call (800) 348-1212 - Beneficiary Form for UA Life Insurance
- W4 Form
- UA Change form
(To change address, name, or marital
status. Updates UA, PERS/TRS and Blue Cross only.
To update address with ORP or pension vendor,
contact the vendor directly)
Still have questions? Send us an e-mail.
