Add/Remove Coverage or Dependents
You will need to complete a 健康 Benefits Change form if you wish to add/remove dependent(s) from your health plans. Supporting documentation will be required. A completed 健康 Benefits change form must be received by 健康 and Wellness within 30 days of a permitting event, unless otherwise noted in the 健康 Benefits Eligibility Policy.
You will need to complete a 健康 Benefits Enrollment Form if you wish to add coverage or a 健康 Benefits Declination Form if you wish to remove coverage. Supporting documentation will be required. The completed form must be received by 健康 and Wellness within 30 days of a permitting event, unless otherwise noted in the 健康 Benefits Eligibility Policy.
Important Notes
- You must have an account for the online forms platform in order to submit a form. Create an account
- As of January 2021, the enrollment forms no longer work with Internet Explorer. If you do not have another browser installed on your work PC, you can fill out a form from your home PC, smart phone, or tablet.
- If you have questions about how to fill out the below forms, see the 健康 Benefits Online 形式 FAQ.
健康 Benefits Change Form for Extra-Help/Temporary Employees
健康 Benefits Enrollment Form for Extra-Help/Temporary Employees
健康 Benefits Declination Form for Extra-Help/Temporary Employees
