Monday, October 15 - Monday, November 19
- Open Enrollment is a period of time each year when employees are given the opportunity to re-visit their benefit plans, change to a new plan, drop a current plan, or newly enroll in plans if you didn't have them before.
- It is not required for employees to make a change. If no change is made, your current status or current plans will stay the same.
- Below is a list of the official forms that can be filled out either electronically or printed and scanned, to be submitted for your benefit change. Underneath the list is detailed information on the options available to you.
Make Your New Elections to be Effective on January 1, 2019!
Click on the green links below to access enrollment/change forms. If you'd like to fill out the forms electronically, please click on the link and then click on Open With above the form to open with the Doc Hub program.
Please email all of your forms to Alyssa Pelow: firstname.lastname@example.org
Fill out this form if you would like to change your Blue Cross Blue Shield Healthcare plan starting in January.
Fill out this form if you would you like to change your Northeast Delta Dental plan starting in January.
Fill out this form if you will be signing up for a DataPath Health Reimbursement Arrangement (HRA).
Fill out this form if you will be signing up for a DataPath Flexible Spending Account (FSA).
Fill out this form if you will be signing up for a DataPath Health Spending Account (HSA).
You can register to view your Health FSA or Dependent Care balance through this link.
- These are the monthly premiums you'll be paying starting in FY20. This rate doesn't include the 85% coverage from WCSU, based on a Gold CDHP Plan and FTE status.
- Please note that these rates are proposed. You will be notified when the rates are finalized.
- Northeast Delta Dental monthly premiums will remain the same. If any changes are made, you will be notified.