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Office of Human Resources

Family Status Changes

Family status changes are - Marital Changes (Marriage, Divorce, Legal Separation, Annulment, or Death of Spouse) or Dependent Changes (Birth, Adoption, Placement of Adoption, or Death of Dependent)

Forms that must be completed as a result of a marital status change are:

All name changes require proof, such as a copy of your marriage certificate, divorce decree, license or Social Security card with the new name. (NOTE: Retirement companies require a marriage certificate or divorce decree.)

Health Care Plans To add or remove your spouse/dependent child(ren) from your Health Care Plan, you will need to complete the Enrollment/Change Form and return it to the Benefits Office within 30 days of the date of the qualifying family status change.
Dental Assistance Plan To add or remove your spouse/dependent child(ren) from your Dental Plan, you will need to complete the Enrollment/Change Form and return it to the Benefits Office within 30 days of the date of the qualifying family status change.
Flexible Spending Accounts (FSAs) To enroll in or make changes to the FSA program, you will need to complete the Enrollment/Change Form . The enrollment/change will be effective as of the date of the qualifying family status change.

Currently enrolled: You have 30 days from the date of the qualifying family status change to make any necessary changes to your FSA.

Not currently enrolled: You have 30 days from the date of the qualifying family status change to enroll in the FSA program.
University-Paid Basic Term Life Insurance Changes to beneficiary designations can be done online at www.rochester.edu/people and click on "Securian Life". Forms are available by contacting Securian Life at 1-800-941-2192 or e-mail lifebenefits@securian.com .
Group Universal Life (GUL) Insurance

Group Optional Term Life (GOTL) Insurance

Dependent Term Life Insurance
Changes to beneficiary designations can be done online at www.rochester.edu/people and click on "Securian Life". Forms are available by contacting Securian Life at 1-800-941-2192 or e-mail lifebenefits@securian.com .

Note: Within 90 days of a qualifying family status change, you may enroll in or increase your GUL/GOTL and Dependent Term Life insurance online at www.rochester.edu/people and click on "Securian Life". Forms are available by contacting Securian Life at 1-800-941-2192 or e-mail lifebenefits@securian.com . You will need to notify Securian Life when your dependents are no longer eligible for coverage (i.e. divorce/termination of a domestic partnership) by completing a Life Insurance Change Request form available online, by calling 1-800-941-2192 or by sending an e-mail to lifebenefits@securian.com .
Retirement Program To change your name and/or the beneficiaries listed on your University of Rochester Retirement Program investment account at TIAA-CREF, you will need to complete the applicable Beneficiary Designation Form(s).

*Please note that under federal law, you are required to list your spouse at least 50% primary beneficiary, unless (s)he waives that right.
Tuition Benefits Your dependent children may be eligible for tuition benefits .


Many forms are available online .   Any forms not available online can be obtained by contacting the Benefits Office (Medical Center Room G-8011) at 585-275-2084 or benefitoffice@hr.rochester.edu .