State Group Health Insurance
If you had Family coverage before the divorce, you will need to submit a Health Insurance Information Change Form to delete your ex-spouse, to report your marital status change and, if applicable, change your name. If there are no children (dependents), you should submit a Health Insurance Application instead of the Change Form to change to single coverage. Upon notification of the divorce, the UWM Benefits Office will send your ex-spouse a Continuation/Conversion Notice. Coverage for your ex-spouse (and stepchildren) will cease at the end of the month in which your divorce is granted. Refer to the Continuation of Health Insurance section in your It's Your Choice booklet for more information.
If you had Single coverage before the divorce, you will need to submit a Health Insurance Information Change Form to show your marital status change and, if applicable, your name change.
Applications should be submitted to the UWM Benefits Office.
State Group Life Insurance: Minnesota Life Insurance Company
If you have Spouse and Dependent coverage, your ex-spouse can convert his/her coverage to an individual policy. Your ex-spouse should contact the Minnesota Life Insurance Company at (608) 277-8690 for conversion information. If there are no eligible children, you must complete an application/cancellation form to discontinue Spouse/Dependent coverage. Submit the form to the UWM Benefits Office.
Individual and Family Group Life Insurance: Minnesota Life Insurance Company
If you had Spouse coverage before the divorce, your ex-spouse can convert his/her coverage to an individual policy. Your ex-spouse should contact Minnesota Life Insurance Company at (608) 277-8690 for conversion information. You must complete a form (UWS-8) to discontinue the deduction for your ex-spouse's coverage. If the coverage change form is not filed, the deduction for your ex-spouse's coverage will continue and cannot be refunded. Submit the form to the UWM Benefits Office.
Accidental Death & Dismemberment: Zurich Insurance Company
If you had a Family plan, you must complete an application to change to Employee only if there are no eligible children. Submit the application to the UWM Benefits Office.
Major Medical and Dental Insurance: Epic
If you have Family coverage or Two-Person coverage, you must complete an application to delete coverage for your ex-spouse (and stepchildren) and, if appropriate, to change to Two-Person or Single coverage. Submit the forms to the UWM Benefits Office. Continuation/conversion information will be forwarded.
Dental Insurance
Unclassified Employees and Non-Represented Classified Employees
If Family coverage has been in effect, you should complete an application to report your change in marital status and (if there are no eligible children) to change to Single coverage. The application should be submitted to the UWM Benefits Office. For continuation information, your ex-spouse should contact the UWM Benefits Office.Represented Classified Employees
Contact your union local regarding requirements and procedures.
Employe Reimbursement Account Program
If you have a Dependent Care or Medical Expense account in effect, you may be able to adjust or cease your contributions. The change you make must be consistent with how your divorce has affected your expenses in these areas. If you do not have an ERA account in effect, you may be able to start one or both. You must submit a completed Family Status Change Form to Fringe Benefits Management Company within 30 days of the divorce.
You would also have the opportunity to waive the automatic premium conversion part of the ERA program, or retract a waiver if you had waived this benefit previously. You must take action within 30 days of your divorce.
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Last modified: January 5, 2004
