Life Events occur when changes arise in your personal situation. Significant Life Events make you eligible for special mid-year changes, which could include: adding or removing dependents from your healthcare coverage, altering current Life Insurance and AD&D levels, and electing and/or changing Reimbursement Account elections amounts. Please see the documents below for further information.
All Life Event changes must be completed within 30 days after the date the event occurred.
Examples of Significant Life Events include (but are not limited to):
- Birth/Adoption of a child
- Loss of primary healthcare coverage
Return all completed forms to the HR Benefits Unit unless otherwise noted.
Birth/Adoption of a Child Checklist
Utilize this checklist in order to ensure that you are taking all the necessary steps associated with having and/or adopting a baby and adding that baby to your healthcare coverage.
Membership & Record Change Form
Add or remove members from your Health, Dental, and Vision coverage due to a Significant Life Event. Be sure to include the required legal documents with this form.
Supplement to Membership & Record Change Form
Must complete when removing a spouse and/or child(ren) from your Medical, Dental, and/or Vision coverage. Must accompany Membership & Record Change Form.
Name & Marital Status Change Form
Change your name and/or marital status on your official County record. This form will also be used to change your name and/or marital status with all your Health Plan providers and Retirement & Deferred Compensation accounts (if you are enrolled in these programs). Return this completed form to the HR Employee Records Unit.
Address Change Form
your address on your official County
record. This form will also be used to change your address
with all your Health Plan providers and Retirement & Deferred
Compensation accounts (if you are enrolled in these programs). Return this completed form to the HR Employee Records Unit.
Family Status Change Form
Make changes to your current Natural Select benefit choices due to a Significant Life Event. This change must comply with a permitted action listed on the chart attached to this form. This form is only used to alter your choices, not add/remove members. Must accompany Membership & Record Change Form.
Life Insurance Beneficiary Change Form
Change the beneficiary for your life insurance coverage.
The Hartford Evidence of Insurability Form (EOI)
Complete this form if you raise your Life Insurance more than one level above its current amount due to a Significant Life Event.
W4 (Federal) & MI-W4 (State of Michigan) Forms
Change your federal and/or state withholding allowance. Return this completed form to the Fiscal Services/Payroll Unit.
Last Paycheck Beneficiary Form
Change the beneficiary for your last County paycheck. Return this completed form to the Fiscal Services/Payroll Unit.
Retirement Forms (Defined Contribution 401(a), Deferred Compensation 457, etc.) can be found here.