Life Events and Your Benefits

Life events affect employee benefit plans in differing ways. Review how your specific life event affects the benefit plan(s) you enrolled in by selecting the event from the following topics:

Marriage


State Group Health Insurance

EPIC Benefits+

  • Change from single to limited family (2 person) or family coverage (or limited family to family):

    Complete a new EPIC Benefits+ Application (E11444) indicating "Adding Dependent," including the appropriate information. List all family members to be covered. Submit the completed application to your payroll and benefits office within 30 days of the marriage. Coverage is effective the date of the marriage.

  • A name/address change can be made using this form. Additionally, complete an EPIC Benefits+ Application (E11444) with your new address.
  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form.

Dental Wisconsin Insurance

  • Change from employee to employee+spouse or employee+child or family:

    Complete a Dental Wisconsin Enrollment Form (UWS 64) indicating "Change," including the appropriate information. Submit the completed application to your payroll and benefits office within 30 days of the marriage. Coverage is effective the date of the marriage.

  • Enroll if not currently insured:

    Complete a Dental Wisconsin Enrollment Form (UWS 64) and submit the completed application to your payroll and benefits office within 30 days of the marriage. Coverage is effective on the first of the month after the application is received, unless there is a claim between the date of marriage and the first of the month. The effective date will then be adjusted to the date of marriage.

  • A name/address change can be made using this form. Additionally, complete a Dental Wisconsin Enrollment Form (UWS 64) with your new address.

VSP Vision Insurance

  • Change from employee/applicant only to employee/applicant + spouse/domestic partner, or employee/applicant + child(ren), or employee/applicant + family:

    Complete a Vision Plan Application (UWS 66) indicating in Section II "Adding Dependent(s)," enter the event date (date of marriage) and check the "Marriage" box. Select your desired coverage in Section III. Enter spouse (and dependents, if applicable) information in Section IV. Submit the completed application to your payroll and benefits office within 30 days of the marriage. Coverage is effective the date of the marriage.

  • Enroll if not currently ensured:

    Complete a Vision Plan Application (UWS 66) and submit the completed application to your payroll and benefits office within 30 days of marriage. Coverage is effective the date of the marriage.

  • A name/address change can be made using this form. Additionally, complete a Vision Plan Application (UWS 66) with your new address.

Employee Reimbursement Account (ERA)

  • Add a new Dependent Care Account or change election amount:

    Complete a Change in Status Form and submit the completed form to the local plan administrator at the address on the form within 30 days of the marriage. Coverage will be effective on the first day of the month on or after receipt of the Change in Status Form.

State Group Life Insurance

  • Add spouse and dependent coverage, if not previously eligible:

    Complete a Life Insurance Application (ET-2304) and indicate the number of units of spouse and dependent coverage. Submit the application to your payroll and benefits office within 30 days of the marriage. Coverage is effective on the first day of the month following the receipt of your application.

  • Adding spouse (and stepchildren) to existing spouse and dependent coverage:

    No new application is necessary; coverage is automatic.

  • Enroll for one level of employee coverage if not currently insured, or increase employee coverage by one level:

    Complete a Life Insurance Application (ET-2304). Check the "Enrollment of Coverage Increase Due to Family Status Change" box. Check the box next to the coverage level that you wish to add in Section 3, Coverage Selection. Submit the completed application to your payroll and benefits office within 30 days of the marriage. Coverage is effective the first of the month after the application is received.

  • If you missed a deadline to add spouse and dependent coverage:

    Complete an Application—Evidence of Insurability (ET-2305) and submit it to the Department of Employee Trust Funds (ETF) at the address listed on the application. There is no enrollment deadline to apply through Evidence of Insurability.

    Two married state employees may both carry spouse and dependent coverage.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (ET-2320) and submit the form to ETF at the address listed on the form.

Individual & Family Group Term Life Insurance

  • Add spouse (and child) coverage:

    Complete an Individual & Family Group Life Insurance Application (UWS 1301) and submit it to your payroll and benefits office within 30 days of the marriage. Coverage is effective the first of the month following receipt of the application.

    Stepchildren are automatically covered if child coverage is in place at the time of the marriage.

    A spouse who is an employee of the university may be insured as an employee or as a spouse, but not both. Only one employee-parent in a family may carry child coverage.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (UWS 1305) and submit the completed form to the address listed on the form.

University Insurance Association (UIA) Life Insurance

UW Employees, Inc. Life Insurance

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form and submit the completed form to the address listed on the form.

Accidental Death & Dismemberment Insurance (AD&D)

  • Change from single to family coverage:

    Complete a new Enrollment/Change Form (UWS 1245) and select your coverage amount. Submit the application to your payroll and benefits office. Coverage is effective on the first day of the month following receipt of the application. There is no enrollment deadline to make changes for AD&D.

    A new spouse and stepchildren are automatically covered if family coverage is already in place.

    If both spouses are employees of the University of Wisconsin and enroll in the plan, a spouse will not be insured as a covered spouse under the partner's family coverage. Only one spouse may select the family plan.

  • To update your beneficiary designation:

    Complete the Beneficiary Designation Form (UWS 1247) and submit the completed form to your payroll and benefits office.

Wisconsin Retirement System (WRS)

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (ET-2320) and submit the completed form to ETF at the address listed on the form.

  • An address change can be made in your WRS account using this form and this form. A name change must be processed through the Office of Human Resources.

Tax Sheltered Annuities (TSA)

Wisconsin Deferred Compensation (WDC) Program

Tax Filing Status

Divorce


State Group Health Insurance

  • Delete former spouse and any stepchildren from family coverage:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed form to your payroll and benefits office. Coverage on your former spouse and stepchildren will cease at the end of the month in which the marriage is terminated by divorce or annulment, or to the end of the month in which the COBRA notice is provided to the divorced spouse, whichever is later.

    If you fail to provide timely notice of divorce, you may be responsible for premiums paid in error which covered your ineligible ex-spouse and stepchildren.

  • Change from family to single coverage, if no other dependents:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed form to your payroll and benefits office. Coverage on your former spouse and stepchildren will cease at the end of the month in which the marriage is terminated by divorce or annulment, or to the end of the month in which the COBRA notice is provided to the divorced spouse, whichever is later.

    If you fail to provide timely notice of divorce, you may be responsible for premiums paid in error which covered your ineligible ex-spouse and stepchildren.

  • A name/address change can be made using this form. Additionally, complete a Group Health Insurance Application/Change Form (ET-2301) with your new address.

If you fail to provide timely notice of divorce, you may be responsible for premiums paid in error which covered your ineligible spouse and stepchildren.

COBRA/Continuation rights for the State Group Health Insurance program will be given to your former spouse (and stepchildren). You will need to supply your former spouse's current mailing address.

EPIC Benefits+

  • To delete spouse and continue to carry family coverage:

    Complete a new EPIC Benefits+ Application (E11444) indicating "Delete," including the appropriate information, including the date of the divorce. Submit the completed form to your payroll and benefits office. Coverage ends the date the divorce decree is entered.

  • Reduce your level of coverage from family coverage or limited family (2 person) to single coverage (or family to limited family):

    Complete a new EPIC Benefits+ Application (E11444) indicating "Removing a Dependent," including the appropriate information. Submit the completed form to your payroll and benefits office. Coverage is effective the first of the month following the receipt of the application.

  • A name/address change can be made using this form. Additionally, complete an EPIC Benefits+ Application (E11444) with your new address.
  • Update beneficiary designation:

    Complete a Beneficiary Designation Form.

COBRA/Continuation rights for the EPIC Benefits+ insurance program will be given to your former spouse (and stepchildren). You will need to supply your former spouse's current mailing address.

Dental Wisconsin Insurance

  • Delete spouse and continue employee+child or family coverage:

    Complete a Dental Wisconsin Enrollment Form (UWS 64) indicating "Change," including the appropriate information for all family members who are to remain on the program. Check the appropriate boxes for plan type chosen and desired coverage level, and insert the date of the divorce in the Divorce/Termination of Domestic Partnership box. Submit the completed application to your payroll and benefits office. Coverage ends at the end of the month in which the divorce decree is final.

    Failure to do this in a timely manner could result in overpayment of premium by you.

    COBRA/Continuation rights for the Dental Wisconsin insurance program will be given to your former spouse (and stepchildren). You will need to supply your former spouse's current mailing address.

  • A name/address change can be made using this form. Additionally, complete a Dental Wisconsin Enrollment Form (UWS 64) with your new address.

VSP Vision Insurance

  • Change coverage:

    Complete a Vision Plan Application (UWS 66) indicating in Section II "Deleting Dependent(s)," enter the "Event Date" (date of divorce), list the "Dependent(s) to be Deleted" and check the "Divorce" box. Select your desired coverage in Section III. In Section IV enter the appropriate information for all family members who are to remain on the program. Submit the completed application to your payroll and benefits office. Coverage ends at the end of the month in which the divorce decree is final.

    Failure to do this in a timely manner could result in overpayment of premium by you.

    COBRA/Continuation rights for the VSP Vision Insurance program will be given to your former spouse (and stepchildren). You will need to supply your former spouse's current mailing address.

  • A name/address change can be made using this form. Additionally, complete a Vision Plan Application (UWS 66) with your new address.

Employee Reimbursement Account (ERA)

  • Enroll in a Medical Account (if you lost coverage under your former spouse's plan), Add a new Dependent Care Account, or change current election amount:

    Complete a Change in Status Form and submit the completed form to the local Plan Administrator within 30 days of the divorce at the address on the form.

State Group Life Insurance

  • To delete spouse and dependent coverage (if you have no other eligible dependents to cover):

    Complete a Life Insurance Application/Cancellation/Refusal form (ET-2304), checking the cancellation box and indicating the coverage to be deleted. Submit the completed form to your payroll and benefits office. Coverage ends the date the divorce decree is entered.

    If you have eligible dependents who still need coverage, you do not need to complete any forms.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (ET-2320).

Individual & Family Group Term Life Insurance

University Insurance Association (UIA) Life Insurance

UW Employees, Inc. Life Insurance

Accidental Death & Dismemberment (AD&D)

  • Change from family plan to single plan if you do not have any other eligible dependents to cover:

    Complete an Enrollment/Change form (UWS 1245) indicating "Change in Coverage." Check the "Employee Only Plan" box and then select the amount of coverage. Submit the completed form to your payroll and benefits office. Coverage ends at the end of the month in which the divorce decree is entered.

    If you have eligible dependents to cover, no form needs to be completed.

  • Update beneficiary designation:

    Complete the Beneficiary Designation Form (UWS 1247) and submit the completed form to your Payroll and Benefits office.

Wisconsin Retirement System (WRS)

Tax Sheltered Annuities (TSA)

Wisconsin Deferred Compensation (WDC) Program

Tax Filing Status

Domestic Partnership


For the definition, specific criteria, forms and other additional information, see Benefit Options for UW Employees With Domestic Partners.

State Group Health Insurance

  • Change from single to family coverage:

    Send a notarized Affidavit for Domestic Partnership (ET-2371) to ETF, if there is not one on file. Retain a copy for your records. ETF will send an acknowledgement letter indicating the affidavit has been received and accepted. Next, complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed application to your payroll and benefits office within 30 days of the date of establishment of the domestic partnership as noted by ETF in the acknowledgement letter. Coverage is effective the date of the establishment of the domestic partnership. For more in-depth instructions, please visit our Add a Domestic Partner page.

  • Add domestic partner/dependent of domestic partner to existing family coverage:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed application to your payroll and benefits office within 30 days of the date of establishment of the domestic partnership as noted by ETF in the acknowledgement letter. Coverage is effective the date of the establishment of domestic partnership. For more in-depth instructions, please visit our Add a Domestic Partner page.

  • Enroll if not currently insured:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed application to your payroll and benefits office within 30 days of the date of establishment of the domestic partnership as noted by ETF in the acknowledgement letter. Coverage is effective the date of the establishment of domestic partnership. For more in-depth instructions, please visit our Add a Domestic Partner page.

  • Change from one plan to another:

    Complete a Group Health Insurance Application/Change Form (ET-2301) to add your domestic partner/dependent of domestic partner to your existing plan with coverage effective the date of establishment of domestic partnership and submit the completed application to your payroll and benefits office within 30 days of the date of establishment of domestic partnership as noted by ETF in the acknowledgement letter.

    Next, complete a second Group Health Insurance Application/Change Form (ET-2301) to change from one plan to another and submit the completed application to your payroll and benefits office within 30 days of the date of establishment of domestic partnership as noted by ETF in the acknowledgement letter. Coverage will be effective on the first day of the month following receipt of the application. For more in-depth instructions, please visit our Add a Domestic Partner page.

  • An address change can be made using this form. Additionally, complete a Group Health Insurance Application/Change Form (ET-2301) with your new address. For more in-depth instructions, please visit our Add a Domestic Partner page.

Dental Wisconsin Insurance

  • Change from employee to employee + spouse/domestic partner or family:

    Complete a new Dental Wisconsin Enrollment Form (UWS 64) indicating "Change," including the appropriate information and a copy of the Affidavit (UWS 50). Submit the completed application to your payroll and benefits office within 30 days of meeting the criteria for a domestic partnership.

  • Enroll if not currently ensured:

    Complete a Dental Wisconsin Enrollment Form (UWS 64). Submit the completed application and a copy of the Affidavit (UWS 50) to your payroll and benefits office within 30 days of meeting the criteria for a domestic partnership. Coverage is effective the first of the month after the application is received, unless there is a claim between the date of the domestic partnership and the first of the month. The effective date will then be adjusted to the date for the domestic partnership.

  • An address change can be made using this form. Additionally, complete a Dental Wisconsin Enrollment Form (UWS 64) with your new address.

Employee Reimbursement Account (ERA)

  • Add a new Dependent Care Account or change election amount:

    Complete a Change in Status Form and submit the completed form to the local plan administrator at the address on the form within 30 days of the marriage. Coverage will be effective on the first day of the month on or after receipt of the Change in Status Form.

VSP Vision Insurance

  • Change from employee/applicant only to employee/applicant + spouse/domestic partner, or employee/applicant + child(ren), or employee/applicant + family:

    Complete a Vision Plan Application (UWS 66) indicating in Section II "Adding Dependent(s)," enter the "Event Date" (effective date of domestic partnership) and check the "Domestic Partnership" box. Select your desired coverage in Section III. Enter spouse (and dependents, if applicable) information in Section IV. Submit the completed application and a copy of the Affidavit (UWS 50) to your payroll and benefits office within 30 days of meeting the criteria for a domestic partnership. Coverage is effective the date of the domestic partnership.

  • Enroll if not currently insured:

    Complete a Vision Plan Application (UWS 66) and submit the completed application to your payroll and benefits office. Coverage is effective on the date of the domestic partnership.

  • A name/address change can be made using this form. Additionally, complete a Vision Plan Application (UWS 66) with your new address.

State Group Life Insurance

  • Add spouse and dependent coverage, if not previously eligible:

    Complete a Life Insurance Application (ET-2304) and indicate the number of units of spouse and dependent coverage. Submit the application to your payroll and benefits office within 30 days of the date of establishment of the domestic partnership as noted by ETF in the acknowledgement letter. Coverage is effective on the first day of the month following the receipt of your application.

  • Adding domestic partner (and stepchildren) and existing spouse and dependent coverage:

    No new application is necessary; coverage is automatic.

  • Enroll for one level of employee coverage if not currently insured, or increase employee coverage by one level:

    Complete a Life Insurance Application (ET-2304). Check the "Enrollment of Coverage Increase Due to Family Status Change" box. Check the box next to the coverage level that you wish to add in Section III, Coverage Selection. Submit the completed application to your payroll and benefits office within 30 days of the date of establishment of the domestic partnership as noted by ETF in the acknowledgement letter. Coverage is effective the first of the month after the application is received.

  • If you missed a deadline to add spouse and dependent coverage:

    Complete an Application-Evidence of Insurability (ET-2305) and submit it to ETF at the address listed on the application. There is no enrollment deadline to apply through Evidence of Insurability.

    Two state employees in a domestic partnership may both carry spouse and dependent coverage.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (ET-2320) and submit the form to ETF at the address listed on the form.

Individual & Family Group Term Life Insurance

University Insurance Association (UIA) Life Insurance

UW Employees, Inc. Life Insurance

Accidental Death & Dismemberment (AD&D)

  • Change from single to family coverage:

    Complete a new Enrollment/Change Form (UWS 1245) and select the coverage amount. Submit the completed application to your payroll and benefits office. Coverage is effective the first of the month on or after receipt of the application.

    Domestic partner and children are automatically covered if family coverage is already in place.

    If both partners are employees of the University of Wisconsin and enroll in the plan, a partner will not be insured as a covered spouse/partner under a partner's family coverage. Only one partner may select the family plan.

  • Update beneficiary designation:

    Complete the Beneficiary Designation Form (UWS 1247) and submit the completed application to your payroll and benefits office.

Wisconsin Retirement System (WRS)

Tax Sheltered Annuities (TSA)

Wisconsin Deferred Compensation (WDC) Program

Termination of a Domestic Partnership


For the definition, specific criteria, forms and other additional information, see Benefit Options for UW Employees With Domestic Partners.

University of Wisconsin System Administration

  • Dissolving the Relationship:

    Complete the Affidavit of Termination of Domestic Partnership (ET-2372) and submit the original Affidavit of Termination to your Department's Personnel area for filing. Submit copies of the Affidavit of Termination with any applications to your payroll and benefits office.

    Only one Affidavit for Termination of Domestic Partnership needs to be filed for the current relationship. There is a six-month qualifying period before another domestic partnership can be certified.

State Group Health Insurance

If you fail to provide timely notice of termination of domestic partnership, you may be responsible for premiums paid in error which covered your ineligible domestic partner and their children.

COBRA/Continuation rights for the State Group Health Insurance program will be given to your former domestic partner (and stepchildren). You will need to supply your former domestic partner's mailing address.

Dental Wisconsin Insurance

  • Delete domestic partner and continue employee+1 dependent or employee+2 or more coverage:

    Complete a Dental Wisconsin (UWS 64) indicating "Change," including the appropriate information for all family members who are to remain on the program. Check the appropriate boxes for plan type chosen and desired coverage level, and insert the date of the termination in the Divorce/Termination of Domestic Partnership box. Submit the completed application to your payroll and benefits office, including a photocopy of the Affidavit of Termination of Domestic Partnership. Coverage ends at the end of the month in which the partnership is dissolved as stated on the Affidavit of Termination of Domestic Partnership.

    Failure to do this in a timely manner could result in overpayment of premium by you.

    COBRA/Continuation rights for the Dental Wisconsin insurance program will be given to your former partner (and their children). You will need to supply your former partner's current mailing address.

VSP Vision Insurance

  • Change coverage:

    Complete a Vision Plan Application (UWS 66) indicating in Section II "Deleting Dependent(s)," enter the "Event Date" (date of domestic partnership termination), list the "Dependent(s) to be Deleted" and check the "Domestic Partnership Termination" box. Select your desired coverage in Section III. In Section IV enter the appropriate information for all family members who are to remain on the program. Submit the completed application and a copy of the Affidavit of Termination of Domestic Partnership to your payroll and benefits office. Coverage ends at the end of the month in which the domestic partnership termination is final.

    Failure to do this in a timely manner could result in overpayment of premium by you.

    COBRA/Continuation rights for the VSP Vision insurance program will be given to your former partner (and their children). You will need to supply your former partner's current mailing address.

State Group Life Insurance

Individual & Family Group Term Life Insurance

University Insurance Association (UIA) Life Insurance

UW Employees, Inc. Life Insurance

Accidental Death & Dismemberment (AD&D)

  • To delete family coverage (if you do not have any other eligible dependents to cover):

    Complete an Enrollment/Change form (UWS 1245) indicating "Change in Coverage." Check the "Employee Only Plan" box and then select the amount of coverage. Submit the completed form to your payroll and benefits office, including a photocopy of the Affidavit of Termination. Coverage ends at the end of the month in which the domestic partnership is dissolved as stated on the Affidavit of Termination of Domestic Partnership.

    If you have eligible dependents to cover, no form needs to be completed.

  • Update beneficiary designation:

    Complete the Beneficiary Designation Form (UWS 1247) and submit the completed form to your payroll and benefits office.

Wisconsin Retirement System (WRS)

Tax Sheltered Annuities (TSA)

Wisconsin Deferred Compensation (WDC) Program

Birth/Adoption/Guardianship


State Group Health Insurance

  • Change from single to family coverage:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed application to your payroll and benefits office within 60 days of a birth or adoption, or within 30 days of when legal guardianship is granted. Coverage is effective on the date of birth/adoption/legal guardianship.

  • Add new dependent to existing family coverage:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed application to your payroll and benefits office within 60 days of a birth or adoption, or within 30 days of when legal guardianship is granted. Coverage is effective on the date of birth/adoption/legal guardianship.

  • Enroll if not currently insured and you have a new dependent due to birth, adoption or placement for adoption:

    Complete a Group Health Insurance Application/Change Form (ET-2301) and submit the completed application to your payroll and benefits office within 30 days of the event. Coverage is effective the day of the birth/adoption.

  • Change from one plan to another:

    Complete a Group Health Insurance Application/Change Form (ET-2301) to add a new dependent to your existing plan with coverage effective the date of the event, and submit the completed application to your payroll and benefits office within 30 days of the event. Next, complete a second Group Health Insurance Application/Change Form (ET-2301) to change from one plan to another. Submit the completed application to your payroll and benefits office within 30 days of the event. Coverage will be effective on the first of the month following receipt of the application.

Dental and Excess Medical Insurance (EPIC)

  • Change from single to limited family (2 person), or family coverage (or limited family to family) or remaining on family coverage:

    Complete a new EPIC Benefits+ Application (E11444) indicating "Adding Dependent," including the appropriate information. List all family members that are to have coverage. Submit the completed application to your payroll and benefits office within 60 days of the birth/adoption/legal guardianship. Coverage is effective the date of the child's birth, the date the employee takes custody of the adopted child or the court-appointed date for legal guardianship or adoption of the child.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form.

Dental Wisconsin Insurance

  • Change from employee to employee+child, or family, or add a new dependent to an existing plan:

    Complete a new Dental Wisconsin Enrollment Form (UWS 64) indicating "Change," including the appropriate information, and submit it to your payroll and benefits office within 60 days of the birth or adoption. Coverage is effective the date of the birth or adoption.

  • Enroll if not currently insured:

    Complete a new University of Wisconsin System Group Dental Application (UWS 64) and submit the completed application to your payroll and benefits office within 30 days of the birth or adoption. Coverage is effective the date of the birth or adoption.

VSP Vision Insurance

  • Change coverage:

    Complete a Vision Plan Application (UWS 66) indicating in Section II "Adding Dependent(s)," enter the Event Date (date of birth or adoption) and check the Birth or Adoption box. Select your desired coverage in Section III. Enter information for all family members to be covered in Section IV. Submit the completed application to your payroll and benefits office within 30 days of the birth or legal guardianship and 60 days from adoption. Coverage is effective the date of the birth/adoption/legal guardianship.

  • Enroll if not currently insured:

    Complete a Vision Plan Application (UWS 66) indicating in Section II "Adding Dependent(s)," enter the Event Date (date of birth or adoption) and check the Birth or Adoption box. Select your desired coverage in Section III. Enter information for all family members to be covered in Section IV. Submit the completed application to your payroll and benefits office within 30 days of the birth or adoption. Coverage is effective the date of the birth or adoption.

Employee Reimbursement Account (ERA)

  • Add a new Dependent Care Account or change current election amount:

    Complete a Change in Status Form and submit the completed form to the local plan administrator within 30 days of the birth/adoption/legal guardianship at the address on the form.

State Group Life Insurance

  • Add spouse and dependent coverage, if not previously eligible:

    Complete a new Life Insurance Application (ET-2304) and indicate the number of units of spouse and dependent coverage. Submit the completed application to your payroll and benefits office within 30 days of the birth/adoption/legal guardianship. Coverage for a newborn child is effective the 15th day following the birth. Coverage in adoption or legal guardianship is effective on the first of the month following receipt of the application.

    Additional children are automatically covered if spouse and dependent coverage is in place at the time of birth or adoption.

  • If you missed a previous eligibility period to add spouse and dependent coverage, you can apply through Evidence of Insurability:

    Complete an Evidence of Insurability Application (ET-2305) and submit the completed form to ETF at the address on the application. There is no enrollment deadline to apply through Evidence of Insurability.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (ET-2320) and submit the completed form to ETF at the address on the form.

Individual & Family Group Term Life Insurance

  • Add child coverage:

    Complete an Individual & Family Group Life Insurance Application (UWS 1301) and submit the completed application to your payroll and benefits office within 30 days of the birth or adoption. Coverage for the child, 15 days or older, is effective the first of the month following receipt of the application. Legal wards are not eligible for coverage.

    Additional children are automatically covered if child coverage is in place at the time of the birth or adoption.

  • If you missed a previous eligibility period to add child coverage:

    Complete an Evidence of Insurability Application (03-30538). There is no enrollment deadline to apply through Evidence of Insurability.

  • To update your beneficiary designation:

    Complete a Beneficiary Designation Form (UWS 1305) and submit it to the address on the form.

University Insurance Association (UIA) Life Insurance

UW Employees, Inc. Life Insurance

Accidental Death & Dismemberment (AD&D)

  • Change from single to family coverage:

    Complete a new Enrollment/Change Form (UWS 1245) and indicate the coverage desired. Submit the completed application to your payroll and benefits office. There is no enrollment deadline to make changes to AD&D. Coverage is effective the first day of the month on or after receipt of the application. Legal wards are not eligible for coverage.

  • Update beneficiary designation:

    Complete the Beneficiary Designation Form (UWS 1247) and submit the completed form to your Payroll and Benefits office.

Wisconsin Retirement System (WRS)

Tax Sheltered Annuities (TSA)

Wisconsin Deferred Compensation (WDC) Program

Tax Filing Status

Move


University of Wisconsin–Office of Human Resources

State Group Health Insurance

  • If moving within the health insurance plan's service area:

    Complete a Group Health Insurance Application/Change Form (ET-2301) to update your current mailing address and submit the completed form to your payroll and benefits office.

  • If moving outside the health insurance plan's service area for 3 months or longer (temporary or permanent move):

    Complete a new Group Health Insurance Application/Change Form (ET-2301) to change to another health insurance plan. Include your new address. Submit the completed form to your payroll and benefits office within 30 days of the move. Coverage is effective the first of the month following receipt of the application, but not prior to the date of the move.

  • When returning to the area:

    Complete a new Group Health Insurance Application/Change Form (ET-2301) to change to your previous Health Insurance Plan. Include your new address. Submit the completed form to your payroll and benefits office within 30 days of the move. Coverage is effective the first of the month following receipt of the application.

Dental and Excess Medical Insurance (EPIC)

Dental Wisconsin Insurance

VSP Vision Insurance

  • Complete a Vision Plan Application (UWS 66) indicating in Section II "Change of Name or Address," then complete Section I and Section V only. Submit the completed form to your Payroll and Benefits office.

Employee Reimbursement Account (ERA)

  • Medical account:

    No action is necessary.

  • Dependent care account:

    If a change in residence of the employee, spouse or dependent necessitates a change in dependent care arrangements, complete a Change in Status form and submit the completed form to the local plan administrator within 30 days of the move.

State Group Life Insurance

Individual & Family Group Term Life Insurance

University Insurance Association (UIA) Life Insurance

UW Employees, Inc. Life Insurace

Accidental Death & Dismemberment (AD&D)

Wisconsin Retirement System (WRS)

No action is necessary if the Employee Campus/Home Address Change Form (UW1035) has been submitted.

Tax Sheltered Annuities (TSA)

Wisconsin Deferred Compensation (WDC) Program

Disability — Employee


Contact the Office of Human Resources for an individualized counseling appointment at (608) 262-5650.

Disability — Dependent Child
Continuing Coverage beyond regular age limitations


Disabled Dependent Coverage Provisions by Plan

State Group Health Insurance

  • Complete a State Group Health Insurance application and submit to your Payroll and Benefits office. The Payroll and Benefits office will send the form to ETF who will forward it to the health plan. The health plan will request documentation to support disability. Once approved, ETF will notify the Payroll and Benefits office to add the dependent.
  • To secure coverage prior to plan approval:

    Complete the Application for Continuation Coverage (ET-2311). If the plan approves coverage, COBRA payments can be refunded.

You may be required to verify your dependent's eligibility periodically.

Dental and Excess Medical Insurance (EPIC)

  • Written proof of the child's disabling condition must be provided to EPIC within 31 days of the child attaining age 19. Failure to provide proof will result in termination of the dependent child's coverage.

Dental Wisconsin Insurance

  • Provide Dental Wisconsin proof of incapacity and dependency within 31 days of the child reaching age 19.

VSP Vision Insurance

  • Provide VSP proof of incapacity and dependency within 31 days of the child reaching age 19.

Employee Reimbursement Account (ERA)

  • If the dependent continues to qualify as a tax dependent, no other information is needed.

State Group Life Insurance

  • Complete a Life Insurance Application (ET-2304). You will be required to submit proof of dependency when a claim is filed. Eligibility ceases on the date the disability ceases or the date the child marries, whichever is first.

Retirement


See the Retirement page for complete information. If you are within one year of retirement, contact the Office of Human Resources for an individualized counseling appointment at (608) 262-5650.

Termination of Employment


See the Termination page for complete information. Contact the Office of Human Resources for an individualized counseling appointment at (608) 262-5650.

Active Military Duty


See the Military Leave page for complete information. Contact the Office of Human Resources for an individualized counseling appointment at (608) 262-5650.

Death of an Employee/Dependent/Domestic Partner


Contact the Office of Human Resources for individualized assistance at (608) 262-5650.