University of Minnesota
Office of Human Resources
http://www.umn.edu/ohr
612-625-2016

Same-sex Domestic Partnership Termination

Forms

Termination of Same-Sex Domestic Partnership

Notify Employee Benefits

You are responsible for notifying Employee Benefits by submitting the Termination of Same-Sex Domestic Partnership form. Any false representation or failure to notify the University of termination of partnership may result in disciplinary action up to and including termination or dismissal. You cannot register another same-sex domestic partner for six months following the filing of a Termination of Same-Sex Domestic Partnership form.

In the case of partnership termination, benefits may change for your partner. Below is information about each benefit and process.

Medical and Dental Coverage

When you become separated, your ex-partner and/or ex-partner's children are no longer eligible dependents under your coverage. You will need to contact Employee Benefits for the form to cancel them from your medical and/or dental plans.

  • Medical coverage ends on the last day of the month that includes the end date of the pay period in which the separation becomes final.
  • Dental coverage ends on the last day of the pay period in which the separation becomes final.

Flexible Spending Accounts

Separation allows you to add, cancel, or change the amount in your health care or dependent day care flexible spending account. The change must be requested no later than 30 days after you submit notice of your termination of same-sex domestic partnership.

Same-sex Domestic Partner Life Insurance

If you have life insurance for your former same-sex domestic partner, you will need to cancel the coverage. Your former same-sex partner may continue life insurance by converting to an individual policy if desired. Call Minnesota Life at 651-665-3789 or 800-392-7295 for rates.

Coverage will end on the last day of the pay period in which your separation becomes final.

COBRA Continuation of Coverage

Your former same-sex domestic partner may continue group coverage under state and federal COBRA continuation provisions. Generally, group medical and dental coverage may be continued until the earlier of 36 months following loss of coverage or until your former same-sex partner is covered under another group insurance plan that does not contain an exclusion or limitation for pre-existing health conditions. The full group premium plus a 2% administrative charge will be billed to your former same-sex partner.

To elect continuation of group coverage, your former same-sex partner must complete a Request for Continuation of Coverage form no later than 60 days after you terminate your partnership. Call 612-624-UOHR (612-624-8647) or 800-756-2363 to reach the Employee Benefits Service Center to request the form.

COBRA Information