United Way of King County Intranet

Changes to Your Address, Medical Coverage, Etc.

The United Way of King County offers a few different options on your long-term and short-term disability, medical plans and other benefits. The only time to change those options is in July. We need you to fill out the form below and submit it to us if you want to make any changes to your coverage. You also need to fill out the form for changes in your address, marital status or dependants.

Fill out this form for changes of address, marital status, dependants, or medical coverage
Last Name First Name
Social Security Number
New Address Line 1
New Address Line 2
City State Zip
Home Phone Work Phone
E-Mail Address
Marital Status Single Married	Number of Dependants
Sign me up for short-term disability Cancel my short-term disability	Change me from Group Health to Self-insured Change me from Self-insured to Group Health
Marital Status