Employee Status Changes
Status Changes
Change in Marital Status? Name? New Baby? Child no longer a dependent? New address?
These changes affect your benefits and failure to notify Human Resources could result in payments by you for ineligible services. Marital or dependent status changes must be submitted to Human Resources within 30 days of the qualifying event.
Notifying Human Resources
Step 1: Complete an Name/Address/Phone/Emergency Contact Change Form OR for all other changes a Notice of Change to Benefits Form.
Step 2: Locate your group below and identify any additional action required.
Step 3: Return all completed forms to Human Resources.
Change in Marital Status? Name? New Baby? Child no longer a dependent? New address?
These changes affect your benefits and failure to notify Human Resources could result in payments by you for ineligible services. Marital or dependent status changes must be submitted to Human Resources within 30 days of the qualifying event.
Notifying Human Resources
Step 1: Complete an Name/Address/Phone/Emergency Contact Change Form OR for all other changes a Notice of Change to Benefits Form.
Step 2: Locate your group below and identify any additional action required.
Step 3: Return all completed forms to Human Resources.
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical, Dental & Vision | Teamsters | Contact Teamsters at 360-734-7780 or log into your account | Complete Participant Data Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| Life Insurance | Teamsters Life | Complete Member Information Change Form | Update Beneficiaries Complete Member Information Change Form | Complete Member Information Change Form |
| PERS I, II, III PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| Deferred Compensation 457 Account (Voluntary) | MissionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||
| Complete Member Information Change Form |
| Complete Member Information Change Form |
| Complete Member Information Change Form |
| Complete Member Information Change Form |
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical | Teamsters | Contact Teamsters at 360-734-7780 or log into your account. | Complete Participant Data Form if adding spouse or dependent. Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Dental & Vision | WA Counties Insurance Fund (WCIF) | No further action - HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| PERS I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| Deferred Compensation 457 Account (Voluntary) | MissionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical, Dental & Vision | WA Counties Insurance Fund (WCIF) | No further action HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| PERS I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update. | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| Deferred Compensation 457 Account (Voluntary) | MissionSquare (formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical & Vision | Premera | Complete Change Form | Complete Change Form and Payroll Authorization Form Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Dental | WA Counties Insurance Fund | No further actions - HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| Disability & Life Insurance | FOP via Reliance Standard | Complete Change Form | No further action. | Complete Insurance Enrollment Form |
| LEOFF II | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| Deferred Compensation 457 Account (Voluntary) | MissionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||
| Complete Insurance Enrollment Form |
| Complete Insurance Enrollment Form |
| Complete Insurance Enrollment Form |
| Complete Insurance Enrollment Form |
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical, Dental & Vision | WA Counties Insurance Fund (WCIF) | No further action - HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| PERS I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| Deferred Compensation 457 Account (Voluntary) | MissionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical, Dental & Vision | Teamsters | Contact Teamsters at 360-734-7780 or log into your account | Complete Participant Data From if adding spouse or dependent. Submit with a copy of Marriage/Birth Certificate. Notify your HR Rep if dropping a spouse or dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| Life Insurance | Teamsters Life | Complete Member Information Change Form | Update Beneficiaries | Complete Member Information Change Form |
| PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| Deferred Compensation 457 Account | MissionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||
| Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
|---|---|---|---|---|
| Medical, Dental & Vision | Teamsters | Contact Teamsters at 360-734-7780 or log into your account | Complete Participant Data Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
| Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - If enrolled in additional Voluntary Life Insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
| PERS - I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
| W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
| Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
| 401 (a) (Voluntary) | MIssionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Deferred Compensation 457 Account (Voluntary) | MissionSquare (Formerly ICMA) | Log into your account at MissionSquare Retirement. Follow prompts or call MissionSquare at 800-669-7400. | ||
| Empower (Formerly MassMutual) | Log into your account at Empower. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Empower at 855-756-4738. | |||