Qualified Change in Status

Once you make your elections, you won’t be able to change them until next year’s Open Enrollment, unless you experience a qualifying life event.

qualifying life event

Qualifying Event Change Form

  • Click here to access a downloadable form and complete by filling in the mandatory information.
  • Email this form to: [email protected] with enrollment forms (if required) and supporting documentation.

You must make changes within 30 days of your qualifying life event.