Life Event Declaration Form


Use the Life Event Declaration form in Dayforce to make eligible mid-year benefit changes due to a qualifying life event. After you login to Dayforce, look for the form under Benefits.

See the Life Events section for additional information on allowable changes.

NOTE: This form must be completed and submitted within 31 days of the eligible life event (60 days for newborns).

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Life Insurance and Voluntary AD&D

  • Your Life and Voluntary AD&D insurance coverage is offered through Minnesota Life:

  • Basic Term Life and AD&D Insurance

  • Optional Basic Term Life and AD&D Insurance

  • Optional Dependent Term Life Insurance for your children

  • Voluntary AD&D coverage for yourself or your family

  • Employee Group Universal Life Coverage with optional Cash Accumulation Fund

  • Spouse Group Universal Life Coverage with optional Cash Accumulation Fund


To make changes (i.e. enroll, increase/decrease or cancel) the above coverages, contact Minnesota Life at www.lifebenefits.com or call MN Life at 1-800-843-8358.


401(k)

To enroll in the 401(k) Plan, visit mylife.jhrps.com. As a first time user, you will need to create a User ID by clicking on the Establish User ID and PIN/Password link.


Setting Up Your Account with PayFlex (FSA, HSA)

About a week after your enrollment you will receive an email notice from PayFlex to go out to the HealthHub website. You will want to go out to the site and create an account login.

Here are the directions to set up your account at PayFlex:

  1. Go to http://www.payflex.com
  2. Follow the instructions to create/access your account in the PayFlex User Guide.
  3. Click on the “Employee Account Login” link at the top of the page.
  4. On the next screen click on the “REGISTER” link.
  5. In the Member ID box you will enter in your Social Security Number (with no dashes).
  6. In the Zip Code box you will enter in your home zip code.
  7. Follow the request of the instructions to complete your account activation. Make sure to read through the Online service/fee agreement, check the box that says, “I have read and agreed to the service/fee’s agreement” and click “Continue”

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