Open Enrollment runs from April 21st through May 12th
This page, in conjunction with the newsletter you received, contains all of the enrollment materials and information you will need to make an informed decision during Open Enrollment.
Enrollment Form (for medical, dental and vision benefits enroll, drop or change)
Spousal Surcharge Form (to be completed by ALL district employees annually, regardless of marital status)
Flexible Spending Account (FSA) Form (to be completed annually if you wish to continue this benefit)
Waiver of Medical Insurance Form (to be completed annually if waiving medical)
To update beneficiary information as needed:
Life Insurance Beneficiary Designation Form
403(b) Booklet (Enrollment form is on page 61, Beneficiary form is on page 65)
You will receive an auto response to confirm receipt of your form(s). All forms must be received no later than May 12th. If you do not receive an auto response from Human Resources, it is your responsibility to ensure that you sent the forms to the correct email address before May 12th. Please only send your forms to above email address.
Summaries of Benefits and Coverages (SBC) for medical plans:
Direct Blue Medical Plan SBC PPO Medical Plan SBC
Plans are effective 7/1/17-6/30/18
Glossary of Medical Terms: Click Here
2017 Preventive Schedule: Click Here
2017 governmental notices for health plans:
Below is a list of annual notices about medical and prescription drug benefits, special enrollment rights and federal programs in which you or a dependent may be eligible.
- Children’s Health Insurance Program CHIP Notice
- Consolidated Omnibus Budget Reconciliation Act continuation coverage rights COBRA Notice
- Creditable Coverage for prescription drug coverage and Medicare Creditable Coverage Notice
- Health Insurance Portability and Accountability Act special enrollment rights notice HIPAA Special Enrollment Rights Notice
- Women’s Health and Cancer Rights Act enrollment notice WHCRA Notice
- Mental Health Parity Act Opt-Out Notice MHPA Notice
Telemedicine how to
Dermatologist on call
Please note: This page will expire on 5/13/17 after Open Enrollment ends.