Benefits Change Connection

Enroll in or Change Dental Plan

A qualified change of status will allow you to make changes to a plan outside of Open Enrollment. Any changes must be made within 30 days from the date of the change in status.

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1. Complete the Change of Status form and return it to the campus Human Resources office. (This step is required by the IRS.)
2. Upon receipt of the Change of Status form, the campus Human Resources office will send you a personalized benefit enrollment form to change your plan or coverage, or you may arrange to pick it up.
3. Review the IU Dental plan summary or booklet (see below) and decide what changes you will make to your plan.

For each eligible dependent you add, you will need to provide:

• Full name
• Date of birth
• Social Security Number (or Tax Identification Number) or ITIN

 

Forms and Publications

Change of Status form

IU Dental plan summary

IU Dental plan booklet
    2008
    2009 coming soon