After the initial benefits enrollment period, you may not change your elections unless you experience a qualifying family life event, such as:

  • Marriage, annulment, divorce or death of a spouse
  • Birth, adoption or death of a child
  • Employment change for you, your spouse or a dependent child that results in a loss or gain of health coverage, or other loss or gain of coverage such as Medicaid or Medicare
  • Child loss of eligibility
  • Enrollment or removal of dependents from daycare, which allows changes to your Dependent Daycare Flexible Spending Account

If you are a benefits eligible teammate and have experienced one of these life event changes in the last 31 days, please print the CHS LiveWELL Health Plan Benefits Enrollment and Change Form. Complete the form and follow the instructions to submit it to Benefits Administration.

Benefits Enrollment and Change Form

Required Documentation

Additional documentation is required for all Qualifying Life Events. To ensure your request is processed in a timely manner, please reference the table below and submit the following document with your Benefit Enrollment and Change Form.

Qualifying Life Event Documentation Required
Marriage, annulment or divorce Marriage certificate or Divorce papers
Birth or Adoption Birth Certificate or Adoption papers
Employment change for you, your spouse or a dependent child that results in a loss or gain of health coverage, or other loss or gain of coverage such as Medicaid or Medicare

Proof of end of coverage or start of new coverage

Child loss of eligibility Proof of loss of coverage
Death of a child or spouse Death Certificate
Enrollment or removal of dependents from daycare, which allows changes to your Dependent Daycare Flexible Spending Account

Letter of enrollment or removal from Daycare