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The 2025 Open Enrollment season is now open! Submit your plan changes by Monday, December 8, 2025.

Name Change Notification

If you have recently married or divorce and would like to change your last name, a copy of the supporting legal documents establishing the name change must accompany this form for processing to occur. Examples of a supporting document must be a copy of your certified marriage certificate or divorce decree.

Note: Additionally, as proof of your identity, a copy of your passport, unexpired driver’s license or any government issued ID is required.