What to do if...

 

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

 

Go from HMO to PPO or PPO to HMO plans

BCBS Enrollment Form

 

Drop medical

BCBS Change Form

Stetson University Waiver Form

 

 

Enroll in Blue Medicare

 

Blue Medicare Enrollment Form
 

Waive medical (and you currently waive medical)

Nothing

 

Drop Vision

Vision Care Change Form

DENTAL:

Keep exactly the same coverage Nothing
  Elect medical for the first time Dental Enrollment Form
  Add/drop a dependent Dental Change Form
  To switch from current option to another option (DMO, DPO, DPR)
Dental Change Form
  Drop Dental Dental Change Form
VISION: Keep exactly the same coverage Nothing
  Elect medical for the first time Vision Enrollment/Change Form
  Add/drop a dependent Vision Enrollment/Change Form
  Drop Vision
Vision Enrollment/Change Form

FLEXIBLE SPENDING ACCOUNTS

 

 

AFLAC Flexible Spending enrollment form

LIFE:

Keep exactly the same coverage

Nothing

  Increase Supplemental Amount Evidence of

Insurability Questionnaire

 

Change a beneficiary

Beneficiary Designation form