Open Enrollment in another Employer's Plan

• Add medical and dental coverages by submitting the Qualifying Status Change form (Formerly - Application to Change Insurance Coverage).
• Following the request to add a dependent, you will be asked to provide proof of dependent eligibility. A detailed letter asking for the appropriate documentation will be sent to your home.
• Drop medical and dental coverage by submitting the Qualifying Status Change form (Formerly - Application to Change Insurance Coverage).
• If you are dropping medical coverage for yourself, and you receive the full employer contribution, you must also submit the Waiver of Medical Coverage form and provide acceptable proof of other coverage for yourself and your eligible dependents.
• You cannot change your medical or dental plan administrator.
• You may not change your Medical Dental Expense Account (MDEA) or Dependent Care Expense Account (DCEA).

These changes can be made to your benefits at any time:

• You can make changes to Employee Additional Life, Spouse Life, Employee AD&D, Spouse AD&D, and Short Term Disability, by completing the Optional Application form.
• You can make changes to your Parking Expense Account (PKEA) and Bus Pass/Vanpool Account (BVEA) by completing and returning to SEGIP the Transit Change in Participation form.

Be sure to make these updates if needed:

• Name changes: submit this change to your Human Resource office.
• Address changes: you update your address in Employee Self Service.
• Tax withholdings: contact your agency’s payroll department.
• Retirement account: contact MSRS at [email protected], 651-296-2761, or 800-657-5757.
• Life and AD&D beneficiary changes: Securian Financial (Minnesota Life). 

• In addition to the Qualifying Status Change form (Formerly - Application to Change Insurance Coverage), you must provide a letter from the employer stating the coverage(s) that were added or dropped, the date the Open Enrollment election was made, and the date the coverage(s) begin or end.
• Following the request to add a dependent, you will be asked to provide proof of dependent eligibility. A detailed letter asking for the appropriate documentation will be sent to your home.
• If you are dropping medical coverage for yourself, and you receive the full employer contribution, you must also submit the Waiver of Medical Coverage form. The letter from the other employer must include your name, the coverage you are enrolled in and the date the coverage will begin.

• If you are adding medical and dental, you must submit the application within 30 days of the date the other employer’s open enrollment period ended, including the last day of the open enrollment period.
• If you are dropping medical and dental, you must submit the application within 60 days of the date the other employer’s open enrollment period ended, including the last day of the open enrollment period.

Timing is everything

• An enrollment is completed by submitting the required forms to the SEGIP office no later than the last day of the enrollment period.
• Do not delay submitting your application by the deadline. Contact SEGIP within your enrollment period when there is a delay obtaining documents. Otherwise, late applications will not be processed.
• If the enrollment is not completed within the allowed period, your next opportunity to change your coverage is during the next annual Open Enrollment or upon another qualified life event.

Visit our Find a Form page to access the form you need.

If you need a form to make changes to your pretax accounts, visit the Benefit Resource (BRI) website.