Dependent Change and Subsidy Forms

Dependent Coverage Change Form: Use this form to add or delete dependents from your medical or dental insurance plans. Please complete and send to Human Resources for processing.

Dependent Care Subsidy Form: If you elect to contribute to the Dependent Care Reimbursement Account you must complete this form and send it to Human Resources. If applying for a higher level subsidy you must also submit the copy of your 2011 tax return verifying your Adjusted Gross Income is less than $60,000.

Health Insurance Contribution Credit (HICC): For those employees who have lower household incomes, the cost of health insurance can be a major part of their monthly budget. A Health Insurance Contribution Credit will be available to those with lower household incomes. Bates College employees who can provide documentation of their household income in the form of the front page of their 2011 Income Tax Return will receive a credit based on the level of their income. The amount reported on your tax return as adjusted gross is used in determining your household income.