What You Want To Do

Which Form(s) You Need to Complete & Submit

MEDICAL:

Keep exactly the same coverage

Nothing

Elect medical for the first time

BCBS Enrollment Form

Add/drop a dependent

BCBS Change Form

Dependent Verification Form

Go from HMO to PPO or PPO to HMO plans

BCBS Enrollment Form

Go from High to Low or Low to High options

BCBS Enrollment Form

Drop medical

BCBS Change Form

Stetson University Waiver Form

Waive medical (and you currently waive medical)

Nothing

DENTAL:

Elect Blue Dental for the first time

Blue Dental Enrollment Form

Changes:

Add/Drop Dependents

Change dental options

Blue Dental Change Form

Drop dental

Blue Dental Change Form

VISION:

Keep exactly the same coverage

Elect Vision Select for the first time

Vision Care Enrollment Form

Add or drop a dependent

Drop Vision

Vision Care Change Form

LIFE:

Keep exactly the same coverage

None

Elect supplemental for the first time

Reliance Evidence of Insurability application

Reliance Beneficiary Designation form

Increase supplemental

Reliance Evidence of Insurability application

Decrease or drop supplemental

notify Human Resources

Change a beneficiary

Reliance Beneficiary Designation form

FLEXIBLE SPENDING ACCOUNT

Contribute to either a health care or dependent care (day care) account during the new plan year

Flexible Spending Enrollment Form