Benefits Change Connection

Enroll in or Change Personal Accident Insurance (PAI)

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 PAI plan booklet and decide what changes you will make to your plan.

 

Forms and Publications

Change of Status form

Personal Accident Insurance plan booklet