A Status Change, an IRS qualified event, allows you to make a change in your enrollment elections during the plan year.
Examples under the IRS regulations include marriage, divorce, change in a spouse/partners employment, birth of a new baby,
death of a spouse/partner, and a change in a dependent childs full-time student status.
In order to make a status change to your benefit selections, you will need to download
and complete both the Faculty & Staff Insurance Benefit Enrollment Form
and the Status Change Form from the Forms
section of the Web site.
For the Enrollment Form, you will only need to complete the sections that pertain to the changes you are making. All other
elections will remain the same. For the Status Change Form, you will need to provide the reason you are requesting the change.
Additionally, for certain events, the Forms must be accompanied by copies of documentation such as a marriage certificate, divorce
decree, statement of termination of domestic partnership or birth certificate. Adoption paperwork may also be applicable.
Please note the following:
1. Due to regulations, a change to your benefit elections can only be made within 60 days of the event (ex. If you were married on
9/15, you have 60 days from that date to make changes to your benefits).
2. Both forms must be submitted together and are due in the Benefits department by the last working day of the month prior to the
date you want the change to take place (ex. If you were married on 9/15 and would like to add your spouse for 10/1, the forms are
due in the Benefits department by 9/30).
You may either fax, mail, or deliver the forms in person to the Benefits Department. Please note that the forms must be submitted for
RECEIPT no later than the last working day of the month to make a change, not just postmarked the last day of the month.
Exceptions may be made within the first 10 business days of a month due to timing associated with birth or death.
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Benefits Fax Number:
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(412) 624-3485
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Mailing Address:
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University of Pittsburgh
Benefits Department
200-B Craig Hall
Pittsburgh, PA 15260
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