Enrolling in Benefits While on Unpaid Leave or a Short Work Break
For employees on leave without pay (LWOP) or a short work break (SWB).
Employees currently on leave without pay (LWOP) or a short work break (SWB) must use the appropriate form below to make medical, dental or vision changes during Open Enrollment.
Important Notes:
- Your form must be submitted to UCPath by the close of Open Enrollment on Nov. 20 at 5 p.m.
- Some benefits (e.g., flexible spending accounts) must be enrolled in within 31 days of returning to work. Contact [email protected] for more information.
Working or on paid leave?
No form needed.
Make your elections through UCPath self-service. Any premiums will be deducted from your paycheck.
Open Enrollment Forms
Employees on LWOP or SWB who have chosen to continue coverage during their leave will pay UCPath directly for their benefits premiums (e.g., medical and dental).
- Staff and Faculty Unpaid Leave and Short Work Break Open Enrollment Form
- Postdoctoral Scholar Unpaid Leave and Short Work Break Open Enrollment Form
How to Submit Your Open Enrollment Form
Use one of the following methods to submit your completed form. After your form is processed, you’ll receive an email confirming that your elections have been submitted. By the second week of December, UCPath will email you when your confirmation statement is available in UCPath.
UCPath
- Log in to UCPath using Single Sign-On (SSO).
- Click Ask UCPath, then select Submit an Inquiry.
- Under “What can UCPath assist you with?”, include “LWOP OE.”
- In the detailed description, include the term “LWOP Open Enrollment PDF Form.”
- Submit form by Friday, Nov. 20 at 5 p.m.
- Send your form to [email protected].
- Use LWOP OE as the subject line. If the subject line doesn’t read “LWOP OE,” your form may not be processed.
- Email form by Friday, Nov. 20 at 5 p.m.
Postal Mail
UCPath
14350-1 Meridian Parkway
Riverside, CA 92518
Reminder: Open Enrollment changes made in 2026 will be effective Jan. 1, 2027.