Special Enrollment Notice

View all mid-year changes that are allowed with a qualifying status change and their deadlines to make the change. Some changes allow longer than 31 days to make the change.

Download the Mid-Year Change form that must be filled out, along with the proof of the qualifying status change and submitted to HR by the 31 day deadline. Proof would be something in writing from an HR Office or Health Carrier stating the person’s name and date coverage started/ended.

* If this is enrollment for a newborn, we do not need proof of birth and you do not need the social security number for the child, as we know you do not receive that right away.

If you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in the District’s plans outside of open enrollment,  if you or your dependents lose eligibility under that other coverage. However, you must submit a completed Mid-Year Change form, along with the proof of the qualifying status change  to Human Resources within “31 days” after yours’ or your dependents’ other coverage ends.

In addition, if you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. However, you must request enrollment within “31 days”  after the marriage, birth, adoption, or placement for adoption.

To request special enrollment or obtain more information, contact Stefanie Edenburn, Benefits Coordinator at 503-261-8250 or Stefanie_Edenburn@ddsd40.org