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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. Below are examples of common status changes:

Family Status Changes
Employment Status Changes
  • Marriage or Divorce
  • Birth or Death of Dependent
  • Over Age 25 or Over Age 26 of dependent
  • Dependent/Spouse gains or loses other coverage

The appropriate packet below must be completed and returned within the 31-day timeframe. Along with the packet, you must also submit proof of the qualifying status change. For example, proof of benefits lost include a COBRA or other notice listing medical, dental, or vision coverage ended on a specific date.

To help you estimate the cost changes, please access the Interactive Benefits Cost Worksheet or view the Benefits Cost Worksheet form. If you have questions or need assistance completing the forms, please call (210) 458-4250 or email

Active Employee Packet
Retiree Packet
  1. Employee Insurance Enrollment Form
  2. Proof of Qualifying Status Change
  3. Dependent Documentation (i.e. marriage / birth certificate, etc.)
  1. Retiree Insurance Enrollment Form
  2. Proof of Qualifying Status Change
  3. Dependent Documentation (i.e. marriage / birth certificate, etc.)

The 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

*UNPAID Leave of Absence

While on Leave of Absence without FMLA, no employer premium sharing dollars are available; therefore, full monthly medical premium rates apply.  

Examples include but are not limited to Paternity Leave, Unpaid Academic Leave, Unpaid Military Leave, any Unpaid Leave with no FMLA, etc.

The full monthly medical premium rates apply as follows:

Monthly Medical Rates for Plan Year 2015-2016
(ending August 31, 2016)

Employee Only Employee and Spouse Employee & Child(ren) Employee & Family
$566.96 $1,108.27 $1,012.42 $1,536.81

In addition to the full monthly medical premiums, all voluntary plan premiums including Flexible Spending Accounts are also due monthly. 

While on an unpaid leave of absence, you may be able to waive benefits until you return from leave.  However, in some cases, plans like life and disability may require evidence of insurability to re-enroll upon return from an unpaid leave. 

Upon return from leave, you have 31-days from date of return to reinstate benefits; otherwise, Annual Enrollment in July for September 1st is the next opportunity to enroll in benefits.


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Updated: November 05, 2015