Benefits Open Enrollment Guide

This is your opportunity to make changes to your current Health, Dental, or Vision enrollment. Changes include enrolling in another plan, adding/removing dependents to your contract, or waiving coverage. Proof of dependent status will be required if you are adding dependents to your health, dental, or vision plans. Acceptable forms of documentation include:

  • spouse or domestic partner - marriage license
  • dependent children - birth certificate, adoption agreement, legal gardianship

Be sure to carefully COMPARE the two PPO plan designs to determine the plan design that best suits the needs of yourself and your dependents. Both plans access the same provider network.

Please review the enclosed premium impact summary comparing your premium expense between the two PPO plan designs.

Changing Your Benefits Elections

Print a Benefits Election Form to indicate the CHANGES that you wish to make for the upcoming calendar year, check yes to pretax your premium, sign it.

Employees who are making a change to their health, dental, or vision enrollments will need to attend open enrollment to complete the necessary insurance change form(s).

Bring your completed Benefit Election Form with you. Scheduled dates are Nov 10 & 11 from 9:00 a.m. - 3 p.m. in the Snyder Room, HUB.

All forms must be submitted to HR by Friday, December 4, 2015.

Employees who wish to enroll in the Flexible Spending Program must complete separate form to enroll for the upcoming calendar year.

Click on the following link to access flexible spending information: PayFlex Flexible Spending.

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