Dependent and/or Legal Name Changes

To make a dependent and/or legal name change, please complete the appropriate forms and return them to the Human Resources Department or other organization as detailed below. To change beneficiaries, see the Beneficiary Changes page.

Dependent and/or Legal Name Change Forms

Deadlines

It is an employee's responsibility to notify Pierce County of dependent and/or legal name changes within the time frames stated below to avoid loss of coverage or problems with benefits.

Life Event Notification Deadline

Marriage Within 30 days of marriage date

Divorce Within 30 days of divorce date

Newborn/adopted child Must be added within 60 days of birth or placement

Dependent other than newborn or adopted child Must add or delete within 30 days of dependency occurring or terminating

Legal Name Change It is recommended that Name Change paperwork be turned in as soon as possible in order to avoid problems with your social security record

Important Note

If dependents are not added as stipulated above, you may apply to add existing dependents only during the open enrollment period. Further, if you fail to notify Pierce County within these time frames, you may be liable for expenses incurred by your dependent, or in the case of divorce, your former spouse and/or dependents.

Dependent and/or Legal Name Change Forms

Instructions: First, read the description below for each form to see if the form applies to your life event change. Complete the appropriate forms and return them to the Human Resources Department or other organization as indicated. If you also need to change beneficiaries, see the Beneficiary Changes page.

Deadlines

Employee Procedure Cover Sheet - This form must accompany all changes; complete, sign, date and return the form to the Human Resources Department. Employee Procedure Cover Sheet.

Employee Information Form - The completed and signed Employee Information Form is required to make changes to your personnel record.

Affidavit of Marriage/Domestic Partnership - The Affidavit of Marriage/Domestic Partnership must be completed when adding a spouse or registering a domestic partnership.

Regence BlueShield - If you are a participant of one of the Regence health insurance plans, complete, sign, date and return the Regence Change Form to the Human Resources Department. Regence does not accept changes directly from the member; they must be signed by an HR representative.

Options/Group Health - If you are a participant of the Options/Group Health insurance plan; complete, sign, date and return the Group Health Enrollment and Change Form to the Human Resources Department.

Washington Dental Service - If you are a participant of WDS; complete, sign, date, and return the WDS Enrollment and Change Form to the Human Resources Department.

Willamette Dental of Washington - If you are a Willamette Dental member, complete, sign, date and return the Willamette Dental of Washington Enrollment and Change Form to the Human Resources Department.

Personal Choice Account - Certain family status changes allow a participant to make adjustments to contributions; if you wish to amend your account; complete, sign, date and return to the Human Resources Department a Personal Choice Account Status Change Form.

Social Security (Name Change Only) - Employees needing to make a name change must submit a copy of the Social Security Card displaying the new name, along with the appropriate forms, in order to complete the name change process. The Internal Revenue Service requires the name on the social security card to match the employee's legal name on employer records.

Employee ID Badge - Employees are required to replace their employee ID badge within 2 weeks after submitting paperwork for a legal name change. Contact Human Resources at 253/798-7480 or pchumanresources@co.pierce.wa.us to schedule a replacement.

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