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    Making Changes to Benefits

    Benefit When can I enroll or make changes? Open Enrollment How can I enroll or make changes? Benefit Website
    Medical Within 31 days of hire or first eligible, within 31 days of qualifying life event (marriage, divorce, newborn) or during Open Enrollment period                   Annually in Nov Effective
    Jan 1
    1. Complete Benefits Enrollment Change Form
    2. Fax form to Human Resources (include any supporting documents for qualifying event) 
    Fax # 845-4304.
    www.pchp.net
    Dental www.anthem.com
    Vision

    Within 31 days of hire or first eligible, within 31 days of qualifying life event (marriage, divorce, newborn) or during Open Enrollment period if enrolled in HMP

    Annually in Nov Effective
    Jan 1, if enrolled in HMP

    Initial enrollment occurs at orientation.  To make a change:
    1. Complete Benefits Enrollment Change Form
    2. Fax form to Human Resources at
    Fax: 845-4304

    www.eyemedvisioncare.com
    Health
    Mgt.
    Program
    You may enroll anytime  

    Call 455-4078

    Complete on-line form prior to appointment

     
    Flexible
    Spending
    (FSA)
    Within 31 days of hire or first eligible, within 31 days of qualifying life event or during Open Enrollment period Annually in Nov Effective
    Jan 1
    1. Complete FSA enrollment form.
    2. Fax form to Human Resources 
    Fax: 845-4304.

    www.takecareWageWorks.com

     

    VRS

    Enrolled automatically upon hire

     

    Complete VRS-2 form to designate or change a beneficiary for VRS retirement benefit. Instructions are included on the form.

    www.varetire.org
    Life
    Insur.

    (part of VRS)

    Group Life: Enrolled automatically upon hire 

    Optional Life: You may apply to purchase additional life insurance at any time; if applied for within 31 days of hire or first eligible date, it is guaranteed issue for employee, otherwise coverage must be approved by Minnesota Life.

     

    1. Complete VRS-39 to enroll, increase, decrease or terminate Optional Life insurance coverage. Also, must complete VRS-32 form if application is submitted more than 31 days after hire date or first eligible date to enroll or increase coverage amount.
    2. Fax form(s) to Human Resources 
    Fax: 845-4304.

    Learn more.

    www.varetire.org
    457 Deferred
    Comp
    Plan
    You can enroll, increase, decrease or stop payroll contributions at anytime Anytime Complete a simplified change formto change your contribution amount or stop contributions. Submit to Human Resources. www.icmarc.org

     

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