OPEN ENROLLMENT
Benefits Bulletin 2009

YES, it is that time of year, OPEN ENROLLMENT runs from October 1 - October 31. PLEASE READ THE BENEFITS BULLETIN CAREFULLY; there have been many changes in the health plans, along with a new vision plan and life insurance carries.

Notice of Election

• Active Notice of Election (NOE)
• Active Notice of Election (NOE) - Permanent Part-Time Teacher

Health Insurance

• Certification Regarding Tobacco Use
  
• State Health Plan (SHP)
  • Health Expenses Claim Form and Instructions - 2 pages
  • Prescription Drug Claim Form (Coordination of Benefits/Direct) and Instructions
  • Request for Blue Cross and Blue Shield Card (SHP ID Card)
  • Prescription Drug Mail Order Form and Instructions
• CIGNA HealthCare Network (HMO)
  • Health Expenses Claim Form - CIGNA
  • Prescription Drug Claim Form - CIGNA
• BlueChoice HealthPlan (HMO)
  • Health Expenses Claim Form - BlueChoice

Dental Insurance

• Dental Claim Form and Instructions

Life Insurance

• Life Insurance Planner Worksheet
• Notice of Continuation of Coverage (Basic Life, Optional Life and Dependent Life) and Instructions
• Personal Health Application
• Group Life Insurance Portability Enrollment Form
• Accidental Dismemberment/Loss of Sight Claim Form (employer’s statement, employee’s statement and physician's treatment/statement) (Basic Life, Optional Life)
• Accelerated Benefit (Living Benefit Option)

Long Term Disability (LTD) Insurance

• Basic Long Term Disability Certificate
• Supplemental Long Term Disability Certificate
• Medical History Statement for Late Entrants and Instructions
• LTD Benefits Claim Form packet
  
• Request for Long Term Disability Conversion Materials

Long Term Care (LTC) Insurance

• Long Term Care Fast Facts

MoneyPlu$

• 2010 MoneyPlu$ Enrollment Form
• 2009 MoneyPlu$ Enrollment Form
• MoneyPlu$ Claim Form - 2 pages (interactive version)
• MoneyPlu$ Claim Form - 2 pages (printable version)
• MoneyPlu$ Refusal to Participate Statement
• MoneyPlu$ Worksheets
• MoneyPlu$ Direct Deposit Authorization Form and Terms and Conditions for Participating
• MoneyPlu$ Change in Status Form

Other Forms

• HIPAA Information
• Dependent Social Security Number Form
• Employment Verification Record and Instructions
• Incapacitated Child Certification Form
• Student Certification Form
• Universal Name/Address Change Form