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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.  For example, proof of benefits lost include a COBRA notice listing medical, dental, or vision coverage ended on a specific date, or a copy of last payroll check stub showing deduction for benefit lost.

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

Active Employee Packet

Retiree Packet

The status packet with the documentation may be faxed to (210) 458-7890, scanned and emailed to 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: October 28, 2014