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Data Change Instructions
To change data, the basic rule is to fill out only the information that's changing, but be sure you give us enough information so that we know whose information to change, i.e., the first name, last name and SSN.
Please refer to the Medical Insurance Enrollment form.
- Action box--check the box for Data Change and print the effective date.
- Carrier box--Underline the name of the carriers.
- Personal Information--First and Last Name are necessary. You need not enter the address, unless the Data Change is an address change.
- Social Security Number--Required for the main enrollee! Our database, as well as those of all our insurance carriers are keyed on the SSN.
- Department, Title, Start date Information--Not necessary on a Data Change form, unless this is the information that's changing.
- Dependent Information--Not necessary on a Data Change form.
- Signature of the Main Enrollee--The main enrollee should verify the data change and sign and date a Data Change form, but for a simple address change it is not necessary.
- Accounting Information for Fellows--Not necessary on a Data Change form, unless you are using this form to change this information, instead of a RAD form.
- Chair, Program Director or P.I. Signature--Not necessary on a Data Change form, unless you are using this form to change this information, instead of a RAD form, then it is required.
- Contact Person Name--Required. Since your responsibility as Department Contact person is to keep track of all insurance enrollments, charges, changes, and terminations for your enrollees, we will not process any insurance action that you don't know about.
- Distribution--Send original to the Human Resources Office and retain a copy for the Department and one for the enrollee.