I want to enroll or change health care coverage:


Outside the Annual Benefits Enrollment period, mid-year changes to the medical, dental, and vision plans require a qualifying event. Qualifying events are scenarios such as marriage or birth, adoption, or foster care placement. Visit the “Eligibility and Plan Changes” page for a full list.

Check mark

  • Complete the Benefits Enrollment Form.
  • Enter the date of the qualifying event in the form’s “Qualifying Event Change” section and check the applicable box in the “Reason for Completing form” section.
  • Sign, date, and send the form┬áto Human Resources by e-mail, fax, or intercampus mail.