Reimbursement Account Enrollment Form
For Employees Experiencing a Qualifying Life Event
If you are experiencing a qualifying life event, such as marriage, divorce, birth, or adoption, please complete an online request through the Duke@Work self-service website to enroll or make changes to the health care and/or dependent care reimbursement accounts. The request and required supporting documentation must be submitted within thirty (30) days of the event.
| Form Name | Format |
|---|---|
| Reimbursement Account Enrollment Form✝ (use the "Qualifying Life Event Enrollment" link) | Web |
For Newly Hired Employees
If you are a newly hired employee, you may enroll online through the Duke@Work self-service website to participate in the health care and/or dependent care reimbursement accounts. Make your benefit selections carefully as you will not be able to make changes afterward until the next annual open enrollment period, unless you have a qualifying life event. Enrollment must be completedduring the first thirty (30) days after your date of hire.
✝ If you are having trouble accessing Duke@Work please contact your departmental payroll representative. If you are having difficulty with the benefit enrollment link, please contact the HRIC at 684-5600.
Benefits - Dependent Care Reimbursement Account, Benefits - Health Care Reimbursement Account, Benefits - Reimbursement Accounts