Benefits Change Connection

See also: Selecting a Medical Plan

Enroll in or Change Medical 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 60 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 Medical plan 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 PPO $900 deductible

IU PPO Plus (no new enrollments)

Blue Preferred Primary POS