
3350 East Paris Ave. SE
Grand Rapids, MI 49512
p. 877.274.8796
f. 616.301.2149

Change in Benefit Election Forms
If you have an employee who wishes to make a change in benefit election amounts:
1. Use your Administrative Manual to verify that the change is permissible under IRS regulations by reviewing pages 1-6 and 1-7. More information can be found in Exhibit N under Tab 3.
2. The employee must complete a Change in Benefit Election form - not an Enrollment form. Be sure to provide the type and date of change.
3. The Change in Benefit Election form must be completed within 30 days of the change in status.
4. Forward the form to the CSI Benefits Office by fax at (616) 301-2149.