Status Changes
You have 31 days from the date of the Change of Status event to notify your benefits representative and change your benefit selections. Please reference UT System Office of Employee Benefits Policy 310, Change In Status to determine qualifying status changes.
The appropriate packet below must be completed and returned within the appropriate timeframe. Along with the packet, you must also submit proof of the qualifying status change. To help you estimate the cost changes, access the Benefits Cost Worksheet. If you have questions or need assistance completing the forms, please call (210) 458-4250 or email benefits@utsa.edu.
Active Employee Packet
- Employee Insurance Enrollment Form
- Dependent Information (if applicable)
- Dependent Documentation (if applicable)
- W-4 Form (if applicable)
- Beneficiary Form (if applicable)
- Change of Address Form (if applicable)
- Community Link Service Centers
Retiree Packet
- Retiree Insurance Enrollment Form
- Dependent Information (if applicable)
- Dependent Documentation (if applicable)
- Beneficiary Form (if applicable)
- Change of Address Form (if applicable)
The status packet with the documentation may be faxed to (210) 458-7890, scanned and emailed to benefits@utsa.edu or mailed to
Department of Human Resources - Benefits
University of Texas at San Antonio
One UTSA Circle
San Antonio, TX 78249-1610
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Updated: May 06, 2013