Forms for Enrollment 2014

You can make your 2014 benefit elections on the enrollment form available at the link below. The enrollment form is a Microsoft Excel workbook that calculates rates for each option that you select. Once satisfied with your selections, please print a copy and sign where indicated. Return your printed and signed form to Ruth Sanoy, Office of Human Resources. Be sure to keep a copy for your records.
Also, check your pay advice, or contact the appropriate benefit plan provider after the first of the year, to confirm that your requested elections have been made.

 > 2014 Benefits Enrollment Form (Microsoft Excel file) -  to add or change coverage for any of these plans in 2014:

  • Medical + Vision
  • Dental
  • Health or Dependent Flexible Spending Accounts
  • Optional Life or Accidental Death/Dismemberment

> Cigna Beneficiary Designation Form
> Cigna Evidence of Insurability Form 

 

Last modified on Thursday, January 30, 2014