Plan | Provider | Name / Address Change | Marital Status / Dependent Change |
Beneficiary Change |
---|---|---|---|---|
Medical, Dental & Vision |
Teamsters | Contact Teamsters at 360-734-7780 or log into your account | Complete Participant Data Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. |
Not applicable |
Life Insurance | Standard Life | No further action - HR will update |
Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
Life Insurance | Teamsters Life | Complete Member Information Change Form | Update Beneficiaries Complete Member Information Change Form |
Complete Member Information Change Form |
PERS I, II, III PSERS |
Department of Retirement Systems |
No further action - Finance will update |
Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account (Voluntary) |
Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form |
Complete Flex-Plan Change in Status Form |
Not applicable |
Deferred Compensation 457 Account (Voluntary) |
ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. |
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Mass Mutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |
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Health Savings Account (Voluntary for QHDHP Plan only) |
Optum Bank | Log into your account at Optum Bank. Select "Profile Summary" under your name at the top, follow prompts or call Optum at 877-470-1771. |
Complete Member Information Change Form |
Complete Member Information Change Form |
Complete Member Information Change Form |
Complete Member Information Change Form |
Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
---|---|---|---|---|
Medical | Teamsters | Contact Teamsters at 360-734-7780 or log into your account. | Complete Participant Data Form if adding spouse or dependent. Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
Dental & Vision | WA Counties Insurance Fund (WCIF) | No further action - HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
Life Insurance | Standard Life | No further action - HR will update | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
PERS I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
Deferred Compensation 457 Account (Voluntary) | ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. | ||
MassMutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |
Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
---|---|---|---|---|
Medical, Dental & Vision | WA Counties Insurance Fund (WCIF) | No further action HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
PERS I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update. | Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
Deferred Compensation 457 Account (Voluntary) | ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. | ||
MassMutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |
Plan | Provider | Name / Address Change | Marital Status / Dependent Change |
Beneficiary Change |
---|---|---|---|---|
Medical & Vision | Premera | Complete Change Form | Complete Change Form and Payroll Authorization Form Notify your HR Rep if dropping a spouse/dependent. |
Not applicable |
Dental | WA Counties Insurance Fund | No further actions - HR will update. |
Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. |
Not applicable |
Life Insurance | Standard Life | No further action - HR will update. |
Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
Disability & Life Insurance | FOP via Reliance Standard | Complete Change Form | No further action. | Complete Insurance Enrollment Form |
LEOFF II | Department of Retirement Systems |
No further action - Finance will update |
Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account (Voluntary) |
Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form |
Complete Flex-Plan Change in Status Form |
Not applicable |
Deferred Compensation 457 Account (Voluntary) |
ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. |
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MassMutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |
Complete Insurance Enrollment Form |
Complete Insurance Enrollment Form |
Complete Insurance Enrollment Form |
Complete Insurance Enrollment Form |
Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
---|---|---|---|---|
Medical, Dental & Vision | WA Counties Insurance Fund (WCIF) | No further action - HR will update. | Complete WCIF Enrollment Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
PERS I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
Deferred Compensation 457 Account (Voluntary) | ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. | ||
MassMutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |
Plan | Provider | Name / Address Change | Marital Status / Dependent Change |
Beneficiary Change |
---|---|---|---|---|
Medical, Dental & Vision | Teamsters | Contact Teamsters at 360-734-7780 or log into your account | Complete Participant Data From if adding spouse or dependent. Submit with a copy of Marriage/Birth Certificate. Notify your HR Rep if dropping a spouse or dependent. |
Not applicable |
Life Insurance | Standard Life | No further action - HR will update. |
Update Beneficiaries - if enrolled in additional Voluntary life insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
Life Insurance | Teamsters Life | Complete Member Information Change Form | Update Beneficiaries | Complete Member Information Change Form |
PSERS | Department of Retirement Systems |
No further action - Finance will update |
Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form |
Complete Flex-Plan Change in Status Form |
Not applicable |
Deferred Compensation 457 Account |
ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. |
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MassMutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |
Plan | Provider | Name / Address Change | Marital Status / Dependent Change | Beneficiary Change |
---|---|---|---|---|
Medical, Dental & Vision | Teamsters | Contact Teamsters at 360-734-7780 or log into your account | Complete Participant Data Form if adding spouse or dependent Notify your HR Rep if dropping a spouse/dependent. | Not applicable |
Life Insurance | Standard Life | No further action - HR will update. | Update Beneficiaries - If enrolled in additional Voluntary Life Insurance complete Enrollment/Change Form | Standard Life Beneficiary Designation Form |
PERS - I, II, III LEOFF II PSERS | Department of Retirement Systems | No further action - Finance will update | Update Beneficiaries | DRS Beneficiary Designation Form |
W-4 | IRS | No further action | Complete W-4 Form | Not applicable |
Flexible Spending Account (Voluntary) | Navia Benefit Solutions | Email or call 800-669-3539 or update on your next claim form | Complete Flex-Plan Change in Status Form | Not applicable |
401 (a) (Voluntary) | ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. | ||
Deferred Compensation 457 Account (Voluntary) | ICMA | Log into your account at ICMA Retirement Services. Select "Personal Information" under the "Manage my Account" tab, follow prompts or call ICMA at 800-669-7400. | ||
MassMutual/Hartford | Log into your account at MassMutual Retirement Services. If accessing for the first time, use your SSN as your user name and "108941" as your temporary PIN; or call Mass Mutual / Hartford at 800-528-9009. |