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Human Resources

County of San Luis Obispo

Qualifying Event Documentation

BenXcel Qualifying Event Name

Required Documentation

1. Birth of a Baby, Adoption of a Child or New Legal Guardianship
  • Birth Certificate, Adoption Paperwork or Court Documents
  • Social Security Number added by employee (within 60 days)

2. Marriage or Domestic Partnership

  • Marriage Certificate or Domestic Partnership Affidavit
  • Birth Certificates for Step Children
3. Divorce
  • Divorce Decree or Legal Separation
  • Termination of Domestic Partnership

4. Drop Self and Dependents from Medical due to New Eligibility for Other Group Coverage

–OR –

5. Drop Dependents from Medical, Dental or Vision due to New Eligibility for Other Group Coverage
  • Proof of Coverage containing: carrier name, group/employer name, member name and all covered dependent names, plan name and plan effective date
  • Proof needed individually for medical, dental and vision if making changes to all three

Loss of Eligibility of Other Group Coverage

6. Add Self and Dependents to Medical, Dental and or Vision due to Loss of Other Group Coverage
  • Termination notice from carrier or group stating member name, covered dependent names, group/employer name, plan name and plan termination date or COBRA paperwork
7. Phone Number, Address or Email Change
  • N/A
8. Death of Dependent
  • Death Certificate