Directions for Applying for Benefits due to a Qualifying Event 

If you have one of the following events listed on the next page, you may be eligible to change, cancel or add benefits. You have 30 days from the event to notify the benefits office of your request. If your notification of the event is after 30 days, your next window of opportunity to change benefits will be during the regular Open Enrollment. 


Please complete the following form and submit to the benefits officeyour request to make a change in your benefits.
  • Fax – 901-861-4940, ATTN: Benefits
  • Email – [email protected]
  • Mail – 146 College Street, Collierville, TN 38017
Please also submit your verifying documents for review. (Approval cannot be given without supporting documents.)


Once documents are reviewed and approved, you’ll receive a link with directions on how to make changes to your benefits.


You’ll be notified by phone or email if your request is denied and the reason for the denial.


Once you’ve submitted your changes, updates in applicable benefit systems (Medical, Dental and Vision) are updated weekly.


Any applicable rate changes or adjustments, based on your electionchange, will be reflected in your next pay check.


You may cancel the following benefits at any time. Requests must be made in writing using the Cancel Form enclosed. Please send to the Benefits office. 

  • *Short‐Term Disability 
  • *Long‐Term Disability 
  • *Group Supplemental Life 


*Please remember that canceling the life and/or disability policies may mean that you’ll be subject to “Late Entrance” provisions if you decide to re-enroll at a later enrollment period.