Forms
Employees may make changes to their benefits outside of Open Enrollment only if there is a qualified life event (QLE) such as:
- Loss of Coverage: If you or your dependents lose eligibility for other coverage or if the employer stops contributing towards your or your dependents’ other coverage. Ex., spouse loses a job and the corresponding insurance coverage with that job. Enrollment must be requested within 30 days after your coverage ends (or after the employer stops contributing toward the other coverage.
- Family Status Change: If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. Enrollment must be requested in most cases within 30 days after the marriage, and 60 days after the birth/adoption or placement for adoption. Likewise, in the case of a divorce, legal separation, annulment, or dependent becoming independent, you must request changes within 30 days of such an event.
- Change in Job Status: In addition to the above special enrollments, you may also enroll if you previously waived benefits when initially eligible because your position was part-time (0.50 - 0.79 FTE for staff, 0.50 - 0.74 FTE for faculty) but recently experienced an increase in FTE (expected to continue for three months or longer). Changes must be requested within 30 days of such an event.
If you have a special enrollment, please send your complete Benefits Enrollment form and along with documentation of your qualified change to Human Resources. Documentation may include a certificate of health coverage, COBRA paperwork, birth certificate, marriage certificate, etc.
- SPU HSA Enrollment and Authorization for Payroll Deductions webform
- https://spu.formstack.com/forms/2023_hsa_enrollment_payroll_deduction_authorization
- Aetna Medical Expense Claim Form
- Aetna / CVS Prescription Drug Claim Form
- Aetna's Health App for Mobile Devices - Info Sheet