Child Loses Dependency

Certain qualifying events allow you to make changes in benefits that otherwise are not possible until the annual Open Enrollment period (November 1-30 with the change effective January 1). This summary outlines the benefit plan changes you may need to make as a result of your dependent no longer meeting the requirements for dependency.

Please be sure to make your changes by completing and submitting the appropriate forms to Human Resources within 30 days of the loss of dependency. It is especially important to delete any ineligible dependents from your coverage within the 30-day timeframe to avoid overpaying premiums that would not be refunded. If you do not notify Human Resources within 30 days of the event, you would complete the forms to cancel your dependent; however, if this cancellation affects your insurance payroll deductions the deductions would not change until December. Your December premiums prepay for your January insurance plans.

All forms should be submitted to Human Resources via email (, fax (254-710-3819), mail (One Bear Place #97053) or office delivery (Robinson Tower, Suite 200).

Forms and Documentation

Medical/Prescription Drug and Dental

Benefit Enrollment Application/Change Form

  • Complete this form to cancel dependent from your medical and/or dental plan.
  • The effective date is the date your dependent no longer meets the requirements for dependency.
  • Group Term Life Insurance section would not be completed.
  • Schedule of Insurance Premiums

Tax Form

  • W-4: You may wish to update your number of exemptions.

Flexible Spending Accounts (FSAs)

If you are participating in Flexible Spending Accounts, you may want to decrease your Unreimbursed Medical/Dental FSA contribution.

Life Insurance

This is a good time to reevaluate your life insurance coverage to ensure that you have proper coverage to accommodate the change in your family. You may also need to change your Supplemental Term Life coverage. This change may require that you complete an application form and evidence of insurability form. Forms are available in the Human Resources office.

Retirement Income Plan

This is a good time to review your retirement income plan, investment elections, and contribution amounts to make sure they reflect your financial goals. You may begin, stop, increase, or decrease your contributions.

Questions? Contact Human Resources at (254) 710-2000.