This form is intended for use by Henrico County General Government Employees, not School Employees.
Employees: We must receive this request and supporting documentation within 60 calendar days of your mid-year qualifying event. Changes start the first day of the following month in which we receive all of paperwork and documentation. For births and adoptions, coverage starts on the actual day of the event. Changes are effective the first of the following month, unless for a birth or adoption, which is retroactive to the date of birth or adoption. If the designated number of days (60) has passed, employees must wait until the next Open Enrollment period or experience another qualifying event to make a change. Any changes made must be consistent with the qualifying event experienced. Please consider how the timing of submitting your paperwork will impact the date your change is effective.
Eligible Dependents: Spouse – legal martial relationship; Child – natural, adopted, step, legal guardianship, legal custody, proposed adoption, under age 26 (unless Totally Disabled)
Flexible Spending Accounts: This form is intended for health and dental coverage changes only. If you wish to enroll or change your current elections for your flexible spending accounts (dependent care or healthcare), please contact [email protected].
