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Office of Human Resources Life Status Event Change Form Name (Please Print) Department Extension Life Status Event Change: This portion of the form is used to notify the Office of Human Resources

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What is life status event change?

A life status event change is a significant life event that may impact an individual's insurance coverage or other benefits.

Who is required to file life status event change?

Individuals who experience a qualifying life event such as marriage, divorce, birth or adoption of a child, or job loss are typically required to file a life status event change.

How to fill out life status event change?

To fill out a life status event change, individuals usually need to complete a form provided by their insurance provider or benefits administrator and submit any necessary documentation.

What is the purpose of life status event change?

The purpose of a life status event change is to ensure that individuals have the appropriate insurance coverage or benefits based on their current life circumstances.

What information must be reported on life status event change?

Information such as the date of the life event, any dependents affected, and any changes to personal or contact information may need to be reported on a life status event change form.

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