If you have recently:
· been married or divorced,
· added a son or daughter,
· moved to a new address,
· changed your name,
or your child is no longer eligible for benefits,
you will need to fill out a new enrollment form.
If your marriage status has changed, you will also need to include a copy of either the marriage certificate or divorce decree. If you are adding a dependent, you will also need to include a copy of the birth certificate. If your name has changed, you will also need to include a copy of your drivers license or social security card with your name change.
To add a dependent, spouse or remove a spouse, or change your name, please fill out the below enrollment form and email or fax it and the required documents to us.
