Integrated Service Center

Life Event: Newly Eligible Extended Dependent

Last updated Wednesday, June 1, 2022

Disclaimer: If the information on this page conflicts in any way with HCA documentation, the HCA documentation governs.

This Life Event is when you acquire a new dependent due to their becoming eligible as an extended dependent through legal custody or legal guardianship.

Changes You Can Make to Your Medical and/or Dental Coverage

When this Life Event happens, you can make any combination of the following changes to your medical and/or dental coverage:

  • Enroll your new extended dependent in your medical and/or dental coverage
  • Enroll in medical coverage so you may in turn enroll your new extended dependent* in your medical coverage
  • Change your medical and/or dental coverage (only if you add your new extended dependent to your coverage)

  1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
  2. Download and complete the Extended Dependent Certification form linked in the right-hand sidebar of this page.
  3. Locate/scan a valid court order showing legal custody, guardianship, or temporary guardianship, signed by a Judge or Officer of the Court.
  4. Mail or email (preferred) both completed forms and the scanned copy of the court order to the ISC.

The Washington State Health Care Authority (HCA) will, in turn, review your completed Extended Dependent Certification form and court order. You will receive a letter from the HCA in the mail (at the mailing address you have listed in Workday) letting you know if coverage for your extended dependent has been approved.

Once we have both the approval from HCA and your submitted Enrollment Form, the ISC will enroll your extended dependent into your coverage.

*Individuals other than your new extended dependent cannot be added to your coverage as part of this Life Event.

Effective Date
Enrollment is effective the first day of the month following the later of the event date or the date the PEBB Program certifies the new extended dependent.

Recertification of your extended dependent is required annually; the HCA will communicate information about that procedure to you at the mailing address you have listed in Workday.

Changes You Can Make to Your FSA and/or DCAP

When this Life Event happens, you can make any combination of the following changes only after the HCA has approved your Extended Dependent Certification:

  • Enroll in a Flexible Spending Arrangement (FSA)
  • Increase your FSA contribution amount
  • Enroll in the Dependent Care Assistance Program (DCAP)
  • Increase your DCAP contribution amount

Once you receive the approval letter from the HCA, follow the procedure in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide to submit your changes in Workday. As part of that procedure, you will be required to upload an electronic copy of the Extended Dependent approval letter from the HCA.

Effective Date
Your enrollment(s)/updated contribution amount(s) take effect on the 1st of the month that follows the later of the following dates:

  • The date you submit your changes in Workday
    -or-
  • The date the HCA certifies your new extended dependent

If the later of either date is the 1st of the month, your changes take effect that day.

Related Links

Extended Dependent Certification form (PDF)

Employee Enrollment Change form (PDF)

Information about medical plan choices can be found on UWHR’s Health Insurance pages.