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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 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. Benefits 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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