Employee Status Changes

Status Changes
Change in Marital Status? Name? New Baby? Child no longer a dependent? New address?

These changes affect your benefits and failure to notify Human Resources could result in payments by you for ineligible services. Marital or dependent status changes must be submitted to Human Resources within 30 days of the qualifying event.

Notifying Human Resources
Step 1: Complete an Name/Address/Phone/Emergency Contact Change Form OR for all other changes a Notice of Change to Benefits Form.
Step 2: Locate your group below and identify any additional action required.
Step 3: Return all completed forms to Human Resources.

Master
Local 17
WSNA
Deputy Sheriff's Guild
IBU
Corrections Deputies
Unrepresented

Plan	Provider	Name / Address Change	Marital Status / Dependent Change	Beneficiary Change
Medical, Dental & Vision	Teamsters	Contact Teamsters at 360-734-7780 or log into your account	Complete Participant Data Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent.	Not applicable
Life Insurance	Standard Life	No further action - HR/Finance will update	Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form	Standard Life Beneficiary Designation Form
Life Insurance	Teamsters Life	Complete Member Information Change Form	Update Beneficiaries	Complete Member Information Change Form
PERS I, II, III LEOFF II PSERS	Department of Retirement Systems	No further action - HR/Finance will update	Update Beneficiaries	DRS Beneficiary Designation Form
W-4	IRS	No further action	Complete W-4 Form	Not applicable
Flexible Spending Account (Voluntary)	Navia Benefit Solutions	Email or call 800-669-3539 or update on your next claim form	Complete Flex-Plan Change in Status Form	Not applicable
Deferred Compensation 457 Account (Voluntary)	ICMA	Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400.
MassMutual/Hartford	Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009.
Health Savings Account (Voluntary for QHDHP Plan only)	Optum Bank	Log into your account at Optum Bank. Select "Profile Summary" under your name at the top, follow prompts or call Optum at 877-470-1771.

Plan Provider Name / Address Change Marital Status /
Dependent Change Beneficiary Change

Medical,
Dental &
Vision Teamsters Contact Teamsters at 360-734-7780 or log into your account Complete Participant Data Form if adding spouse or dependent

Notify your HR Rep if dropping a spouse/dependent. Not applicable

Life Insurance Standard Life No further action -
HR/Finance will update Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form Standard Life
Beneficiary Designation Form

Life Insurance Teamsters Life Complete Member Information Change Form Update Beneficiaries Complete Member Information Change Form

PERS I, II, III
LEOFF II
PSERS Department of Retirement
Systems No further action -
HR/Finance will update Update Beneficiaries DRS Beneficiary Designation Form

W-4 IRS No further action Complete W-4 Form Not applicable

Flexible Spending Account
(Voluntary) Navia Benefit Solutions Email or call
800-669-3539 or update on your next claim form Complete Flex-Plan
Change in Status Form Not applicable

Deferred Compensation
457 Account
(Voluntary) ICMA Log into your account at ICMA Retirement Services.
Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400.

MassMutual/Hartford Log into your account at MassMutual Retirement Services.
If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009.

Health Savings Account
(Voluntary for QHDHP Plan only) Optum Bank Log into your account at Optum Bank.
Select "Profile Summary" under your name at the top, follow prompts or call Optum at 877-470-1771.

Complete Member Information Change Form

Plan	Provider	Name / Address Change	Marital Status / Dependent Change	Beneficiary Change
Medical	HMA	No further action. HR will update.	Complete HMA Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent.	Not applicable
Dental & Vision	WA Counties Insurance Fund (WCIF)	No further action HR/Finance will update	Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent.	Not applicable
Life Insurance	Standard Life	No further action - HR/Finance will update	Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form	Standard Life Beneficiary Designation Form
PERS I, II, III LEOFF II PSERS	Department of Retirement Systems	No further action - HR/Finance will update	Update Beneficiaries	DRS Beneficiary Designation Form
W-4	IRS	No further action	Complete W-4 Form	Not applicable
Flexible Spending Account (Voluntary)	Navia Benefit Solutions	Email or call 800-669-3539 or update on your next claim form	Complete Flex-Plan Change in Status Form	Not applicable
Deferred Compensation 457 Account (Voluntary)	ICMA	Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400.
Deferred Compensation 457 Account (Voluntary)	MassMutual/Hartford	Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009.

Plan	Provider	Name / Address Change	Marital Status / Dependent Change	Beneficiary Change
Medical & Vision	Premera	Complete Change Form	Complete Change Form and Payroll Authorization Form Notify your HR Rep if dropping a spouse/dependent.	Not applicable
Dental	WA Counties Insurance Fund	No further actions - HR/Finance will update	Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent.	Not applicable
Life Insurance	Standard Life	No further action - HR/Finance will update	Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form	Standard Life Beneficiary Designation Form
Disability & Life Insurance	CIGNA	Email CIGNA
LEOFF II	Department of Retirement Systems	No further action - HR/Finance will update	Update Beneficiaries	DRS Beneficiary Designation Form
W-4	IRS	No further action	Complete W-4 Form	Not applicable
Flexible Spending Account (Voluntary)	Navia Benefit Solutions	Email or call 800-669-3539 or update on your next claim form	Complete Flex-Plan Change in Status Form	Not applicable
Deferred Compensation 457 Account (Voluntary)	ICMA	Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400.
Deferred Compensation 457 Account (Voluntary)	MassMutual/Hartford	Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009.

Plan	Provider	Name / Address Change	Marital Status / Dependent Change	Beneficiary Change
Medical, Dental & Vision	Teamsters	Contact Teamsters at 360-734-7780 or log into your account	Complete Participant Data From if adding spouse or dependent. Submit with a copy of Marriage/Birth Certificate. Notify your HR Rep if dropping a spouse or dependent.	Not applicable
Life Insurance	Standard Life	No further action - HR/Finance will update	Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form	Standard Life Beneficiary Designation Form
Life Insurance	Teamsters Life	Complete Member Information Change Form	Update Beneficiaries	Complete Member Information Change Form
PSERS	Department of Retirement Systems	No further action - HR/Finance will update	Update Beneficiaries	DRS Beneficiary Designation Form
W-4	IRS	No further action	Complete W-4 Form	Not applicable
Flexible Spending Account	Navia Benefit Solutions	Email or call 800-669-3539 or update on your next claim form	Complete Flex-Plan Change in Status Form	Not applicable
Deferred Compensation 457 Account	ICMA	Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400.
Deferred Compensation 457 Account	MassMutual/Hartford	Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009.