Changing Benefits and Deductions

Mailing Address

You can change your address on my.evergreen.edu.  When you select the Pay History and Information link you will see your current address.  If you select the Update Address link you will be able to verify the address type and make changes.  Payroll uses the Mailing Address type.

If you choose to send us an email to request the address change, please include your full legal name, Evergreen ID number (A#), and complete address including zip code.

Current Coverage - Plans, premiums, and dependents

Use the PEBB Member Coverage page to confirm your current medical and dental plans, premium amounts, and covered dependents.

Family Changes

You can add/or remove a dependent outside of open enrollment within 60 days of a qualifying event.  You will need to download the Employee/Enrollment Change form from PEBB Forms and submit it, along with the required dependent verification and evidence of the event, to the Payroll & Benefits Office. Use the PEBB Medical Benefits Comparison for a side by side comparison of the medical plans. 

The change in enrollment must be allowable under Internal Revenue Code (IRC) and correspond to and be consistent with the event that creates the special open enrollment for the subscriber, the subscriber's dependent, or both. To make a health plan change, the subscriber must submit the required enrollment forms (and a completed disenrollment form, if required). The forms must be received no later than sixty days after the event occurs. Employees submit the enrollment forms to their employing agency. All other subscribers submit the enrollment forms to the PEBB program. Subscribers must provide evidence of the event that created the special open enrollment.

Health plan coverage will begin the first of the month following the later of the event date or the date the form is received. If that day is the first of the month, the change in enrollment begins on that day.

• Enrollment of extended dependents or dependents with a disability will be the first day of the month following eligibility certification.

Dependents will be removed from the subscriber's health plan coverage the last day of the month following the later of the event date or the date the form is received. If that day is the first of the month, the change in enrollment will be made the last day of the previous month.

• If the special open enrollment is due to the birth or adoption of a child, or when the subscriber has assumed a legal obligation for total or partial support in anticipation of adoption of a child, health plan coverage will begin or end the month in which the event occurs.

Other Changes

When you have family changes you may also wish to change your W-4 and beneficiary forms for life insurance and retirement.

Beneficiary Changes

To change your beneficiaries, download the applicable Life Insurance Beneficiary form (PDF) and/or Department of Retirement Systems Beneficiary form. To change beneficiaries for TIAA-CREF you will need to contact them directly at TIAA-CREF.

Optional life insurance coverage

  • To increase the amount of your coverage:  Download the Life and AD&D Insurance/Enrollment Change form and the Life Insurance Evidence of Insurability form from the PEBB Forms web page.  Return the completed forms to the Payroll and Benefits office.
  • To decrease the amount of your coverage: Download the Life and AD&D Insurance/Enrollment Change form from the PEBB Forms web page.  Return the completed form to the Payroll and Benefits office.

Optional long term disability insurance

  • To enroll or decrease your waiting period:  Download the Long Term Disability Enrollment/Change form and the Long Term Disability Evidence of Insurability form from the PEBB Forms web page.  You can mail or hand deliver the completed forms to the Payroll and Benefits office.  We will mail them for you.
  • To increase your waiting period:  Download the Long Term Disability Enrollment/Change form from the PEBB Forms web page.  Turn the completed form into the Payroll and Benefits office.

Contributions to the Washington State Deferred Comp plan

The Deferral Change Request form can be downloaded at the Washington State Deferred Compensation Program/Forms web page.

TIAA-CREF supplemental retirement annuity

  • If you currently contribute to a SRA and wish to change the amount download the Salary Reduction Agreement VIP (PDF). Turn the completed form into the Payroll and Benefits office.
  • If you do not currently have a TIAA-CREF Supplemental Retirement Annuity - you can pick up the enrollment kit at the Payroll and Benefits office or request that one be mailed to you.