Welcome to Open Enrollment for the Benefits Plan Year 2017-2018!
Please print out the form, complete the indicated sections, and return to the HR office. If you are waiving health insurance coverage and receiving a buyback, please attach a copy of the insurance card for your coverage (only employer-sponsored coverage is allowed for an employee to waive the District’s coverage and receive a buyback in lieu of coverage for himself/herself and/or for a spouse/dependent(s)).
Here are some forms that may be useful during this open enrollment period. Please make sure all forms are turned back in to the Human Resources Office by May 12, 2017!
Please visit the Human Resources page for additional information on all of these benefits & programs.
- Classified Staff SchoolCare Enrollment Form-Fillable form
- Professional Staff SchoolCare Enrollment Form-Fillable form
- Admin Staff SchoolCare Enrollment Form-Fillable form
♦ Dental Insurance Enrollment/Change Form – use this form if you are changing your dental membership (complete the form with the membership that should be covered – self, spouse and/or dependents)
♦ Life Insurance Evidence of Insurability Form – this form is used for increases in supplemental life insurance (F/T employees can elect 1-5X salary in supplemental life insurance – this form applies to any newly elected or increased coverage levels), and should be sent to Linda in Human Resources. You must complete a Life Insurance Election form and submit that to the Human Resources Office as well. The increase is subject to the approval of the Cigna underwriting department and will only take effect if the increase is approved. For additional instructions on completing this form, please see this document.
♦ Flexible Spending Accounts (Healthcare & Dependent Care Reimbursement Account) Enrollment Form – to enroll in a healthcare or dependent care reimbursement account. Please note – these accounts do not renew from plan year to plan year, so enrollment is required each year.
Summaries of Benefits & Coverage (required under the ACA):
Open Enrollment Flyers:
Open Enrollment Flyer– SchoolCare
During the month of May, you can increase your supplemental life election by 1X salary without an Evidence of Insurability Form, as long as the total supplemental life insurance election (including your current amount) is less than $200K.
If you are increasing by more than 1X salary, or your increased election amount is greater than $200K, an Evidence of Insurability form will be required and will be subject to underwriting by Cigna. The maximum election is limited to 5X salary.
Supplemental Life Insurance is not available to Administrators (please see the Administrator contract for details).
Flexible Spending Accounts include Healthcare & Dependent Care Reimbursement Accounts, and allow full-time employees to set aside pre-tax dollars for eligible expenses.
Healthcare & Dependent Care Reimbursement Accounts – Plan Overview
Flex Express Guidelines
FSA Eligible Expenses
Flexible Spending Accounts Reimbursement Claim Form
FSA Reimbursements – Direct Deposit Authorization Form
FSA Store Flyer
Benefit Strategies FSA presentation
Online account access instructions
Please make sure you read through the Plan Overview/FSA Brochure in the Dependent Care Reimbursement Accounts section to understand who is an eligible service provider, the restrictions on those eligible for these accounts, and how these accounts interact with any child tax credits you may be seeking on your taxes (seek advice from a professional tax accountant if you have questions on this).
Colonial Life offers some voluntary plans that are available to all regular employees of the District, including part-time staff members. There are a variety of life insurance, disability and insurance programs available – see more information below.
Employees interested in enrolling in Colonial Life Voluntary Benefits should contact George Pouria (978) 273-8725 or firstname.lastname@example.org for enrollment information.
visit our YouVille site