Insurances Medical Dental Life Plan Changes


Employees are to notify Benefits Administration by memo to add dependents due to birth, adoption or marriage within 30 days of the event to be retroactive to that date of the event. Otherwise, the following effective dates apply for:

  1. Dental: the first of the month following receipt of notification.

  2. BC/BS and HAP: the first of the month 90 days after receipt of notification.

  3. SCM and BCN: the next open enrollment period.

Deletion of dependents is effective the first of the month following receipt of written request. It is retroactive in case of death.

During the first 30 days of employment, any change made to life insurance is retroactive to the first day of coverage. After that, the insurer has the right to approve or reject an increase in coverage. A decrease in coverage is effective the first of the month following notification. A change in beneficiary is effective the date of signature.





  1. Obtain appropriate form(s) from Benefits Administration.

  2. Complete form(s).

  3. Send to Benefits Administration.

Benefits Administration

  1. Process change.

  2. Distribute Notice of Staff Benefits Change, form 785, to Payroll and employee.