When you gain eligibility for, and enroll in, Medicaid or CHIP, you can decrease your FSA contribution amount, or cease your contributions altogether.

To do so, follow these steps within 60 days of gaining your eligibility for Medicaid or CHIP:

1. Prepare your supporting documentation – scan documents that serve as proof of the event.
2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

You cannot change your FSA contributions after 60 days of gaining your eligibility for Medicaid or CHIP.

Effective Date
The change to your FSA contribution amount is effective the 1st of the month following the later of either:

1. The date you gained eligibility for Medicaid or CHIP
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st of the month, the enrollment or change in election begins on that day.

Within 60 days of your dependent gaining eligibility for, and enrolling in, Medicaid, you can:

• Remove them from your medical and/or dental coverage. Refer to Procedure A, below.
  -or-
• Change your medical and/or dental plan election. Refer to Procedure A, below.
  -or-
• Decrease your FSA contribution amount, or cease your contributions altogether. Refer to Procedure B, below.

Procedure A

Complete these three steps no later than 60 days after your dependent gains Medicaid eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants Medicaid eligibility:

1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
2. Obtain an Enrollment letter from Medicaid which shows the date that the subscriber’s dependent became entitled to and enrolled in Medicaid.
3. Send the completed form and supporting documentation to UWHR Benefits either via email (preferred) or mail.

Effective Dates
⇒ If removing your dependent from your coverage:
The effective date of the change is the last day of the month of the later of either:

1. The date your dependent gained eligibility for, and enrolled in, Medicaid
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the first day of the month, the remove date is the last day of the previous month.

⇒ If changing your medical and/or dental plan election:
The effective date of the change is the 1st of the month following the later of either:

1. The date your dependent gained eligibility for, and enrolled in, Medicaid
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the 1st of the month, the change takes effect that day.

Procedure B

Complete these three steps no later than 60 days after your dependent gains eligibility for Medicaid:

1. Prepare your supporting documentation – scan documents that serve as proof of the event.
2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
The change is effective the 1st day of the month following the later of either:

1. The date your dependent gained their eligibility for Medicaid
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st day of the month, the change begins on that day.

When your dependent gains eligibility for, and enrolls in, CHIP, you can:

• Remove them from your medical and/or dental coverage. Refer to Procedure A, below.
  -or-
• Change your medical and/or dental plan election IF you remove your dependent who gained eligibility for and enrolled in CHIP. Refer to Procedure A, below.
  -or-
• Decrease your FSA contribution amount, or cease your contributions altogether. Refer to Procedure B, below.

Procedure A

Complete these three steps no later than 60 days after your dependent gains CHIP eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants their CHIP eligibility:

1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
2. Obtain an Enrollment letter from CHIP which shows the date that the subscriber’s dependent became entitled to and enrolled in CHIP.
3. Send the completed form and supporting documentation to UWHR Benefits either via email (preferred) or mail.

Effective Dates
⇒ If removing your dependent from your coverage:
The effective date of the change is the last day of the month of the later of either:

1. The date your dependent gained eligibility for CHIP
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the 1st of the month, the remove date is the last day of the previous month.

⇒ If changing your medical and/or dental plan election:
The effective date of the change is the 1st of the month following the later of either:

1. The date your dependent gained eligibility for CHIP
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the 1st of the month, the change takes effect on that day.

Procedure B

Complete these three steps no later than 60 days after your dependent gains CHIP eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants their CHIP eligibility:

1. Prepare your supporting documentation – scan documents that serve as proof of the event.
2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
The change is effective the 1st of the month following the later of either:

1. The date your dependent gained their eligibility for CHIP
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st of the month, the change takes effect that day.

Within 60 days of losing your eligibility for Medicaid you can:

• Return from waived enrollment in medical coverage. Refer to Procedure A, below.
  -or-
• Enroll in an FSA or increase your FSA contribution amount. Refer to Procedure B, below.

Procedure A

Complete these three steps no later than 60 days after losing your Medicaid eligibility:

1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
2. Obtain a Termination letter from Medicaid which shows the date at which the subscriber lost eligibility for Medicaid.
3. Send the completed form and supporting documentation to UWHR Benefits either via email (preferred) or mail.

Effective Date
Your enrollment is effective the 1st of the month following the later of either:

1. The date you lost your eligibility for Medicaid
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the 1st of the month, your enrollment begins on that day.

Procedure B

Complete these three steps no later than 60 days after losing your Medicaid eligibility:

1. Prepare your supporting documentation – scan documents that serve as proof of the event.
2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
Your enrollment or change is effective the 1st of the month following the later of either:

1. The date you lost your eligibility for Medicaid
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st of the month, the enrollment or change in election begins on that day.

Within 60 days of your dependent losing eligibility for Medicaid, you can:

• Enroll them in your medical and/or dental coverage. Refer to Procedure A, below.
  -or-
• Enroll yourself in medical coverage in order to enroll a dependent who has lost their Medicaid eligibility. Refer to Procedure A, below.
  -or-
• Change your medical and/or dental plan IF you enroll your dependent who lost eligibility for Medicaid. Refer to Procedure A, below.
  -or-
• Enroll in an FSA or increase your FSA contribution amount. Refer to Procedure B, below.

Procedure A

Complete these three steps no later than 60 days after your dependent loses Medicaid eligibility:

1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
2. Obtain a Termination letter from Medicaid which shows the date at which the subscriber’s dependent lost eligibility for Medicaid.
3. Send the completed form and supporting documentation to UWHR Benefits either via email (preferred) or mail.

Effective Date
Enrollment is effective the 1st of month following the later of either:

1. The date your dependent lost their eligibility for Medicaid
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the 1st of the month, the enrollment date is that day.

Procedure B

Complete these three steps no later than 60 days after your dependent loses Medicaid eligibility:

1. Prepare your supporting documentation – scan documents that serve as proof of the event.
2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
Enrollment is effective the 1st of month following the later of either:

1. The date your dependent lost their eligibility for Medicaid
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st of the month, the enrollment date is that day.

When your dependent loses eligibility for CHIP, you can:

• Enroll them in your medical and/or dental coverage. Refer to Procedure A, below.
  -or-
• Enroll yourself in medical coverage in order to enroll a dependent who has lost their CHIP eligibility. Refer to Procedure A, below.
  -or-
• Change your medical and/or dental plan election IF you enroll your dependent who lost eligibility for CHIP. Refer to Procedure A, below.
  -or-
• Enroll in an FSA or increase your FSA contribution amount. Refer to Procedure B, below.

Procedure A

Complete these three steps no later than 60 days after your dependent loses CHIP eligibility:

1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
2. Obtain a Termination letter from CHIP which shows the date at which the subscriber’s dependent lost eligibility for CHIP.
3. Send the completed form and supporting documentation to UWHR Benefits either via email (preferred) or mail.

Effective Date
Enrollment is effective the 1st of month following the later of either:

1. The date your dependent lost their eligibility for CHIP
   -OR-
2. The date the Employee Enrollment Change form is received by UWHR Benefits

If the later of a. or b. is the 1st of the month, the enrollment date is that day.

Procedure B

Complete these three steps no later than 60 days after your dependent loses CHIP eligibility:

1. Prepare your supporting documentation – scan documents that serve as proof of the event.
2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
Enrollment is effective the 1st of month following the later of either:

1. The date your dependent lost their eligibility for CHIP
   -OR-
2. The date you submit your requested changes in Workday.

If the later of a. or b. is the 1st of the month, the enrollment date is that day.