Divorce or legal separation
Death of a dependent
Birth or adoption of a child
Gain or loss of custody of a dependent
Change in your or your dependents' employment
Change in your or your dependents' non-Dartmouth health coverage
Change in residence of you or your dependent(s)
You or your dependent(s) become eligible for Medicare or Medicaid coverage
An open enrollment period for your dependent(s)
Changes to your benefits may only be made mid-year if you have a qualifying mid-year event. Your request must be submitted using the Status Change Form within 30 days of the qualifying mid-year event. Otherwise, changes may only be made during the Open Enrollment period.
You should notify the Benefits Office of your request to make a change using the Status Change Form. (Note: Additional information is also included on pages 1 and 2 of the form.) This may be submitted via one of the following methods to the attention of the Health Benefits Coordinator:
A request for a Status Change may be submitted prior to the qualifying mid-year event or up to 30 days following the event. Any requests received after 30 days will not be processed and you will be required to wait until the Open Enrollment period to make changes to your benefits.Top of page
Your request for a change will take effect either the date of the event or the following first of the month. (Ex. If you were married on July 12, you may choose to have the effective date be August 1.)
Benefits typically run on a monthly basis. It is important to understand that you are charged for either a full month or half month. In the previous example, if you were to make the change effective July 12, you may still need to pay for the entire month of July (should the changes affect your costs).Top of page
You should receive notification via e-mail of your completed request within 14 days. Processing times may vary depending on the time of year.Top of page
Upon receiving notice that your request for a change has been processed, you have the ability to see the change reflected in your FlexOnline account. After logging in, select "View Benefits" to see your current benefits elections. You may also print a confirmation statement for your records from the bottom of this page.Top of page
You may make changes to your medical and dental insurance using the Status Change Form. This includes adding or canceling a dependent to your coverage, changing the plan you are on (medical only), or canceling your coverage completely. Please note that if you are canceling your medical insurance, you should provide information on your other health coverage on the Status Change Form.Top of page
You may make changes to your life insurance using the Status Change Form, however, changes in your life insurance election amount require the submission and approval of a Statement of Health Form to MetLife. Your election to increase your life insurance will not be reflected on FlexOnline until this approval has been received by the Benefits Office from MetLife.
If you wish to change your life insurance beneficiaries, you may do so at any time by going to FlexOnline and choosing "Designate Beneficiaries." This change is immediate once you click "Save."Top of page
Changes to Flexible Spending Accounts may be made using the Status Change Form.
If you are electing to add more money to the account, you will not be able to submit any expenses for reimbursement that were incurred prior to the effective date of change.
If you are electing to reduce your election, you will not be able to reduce it below the amount that you have already been reimbursed from your FSA for eligible expenses.Top of page
Changes to your retirement elections may be made at any time using FlexOnline. Once logged in, you should choose "Retirement Elections." Please keep in mind that depending on the timing of the following payroll cycle, it may take up to one paycheck for your request for a change to take effect.Top of page
In some instances, you and your dependent may both be Dartmouth College employees. If you are both wishing to make changes (ex. switching from one person's insurance to the other's as a result of a reduced full-time equivalent), you must each submit a Status Change Form. Please ensure that the effective date is the same on both forms. It is also ideal to submit the two requests together.Top of page
If you have any questions on whether an event is a qualifying event or the status of your request (if it has been longer than 14 days), you should contact the Benefits Office and ask for either the Health Benefits Coordinator or the Health Benefits Administrator.
Phone: (603) 646-3588
E-mail: firstname.lastname@example.orgTop of page
Last Updated: 10/17/14