C-FB/QCD Dental Enrollment

  

October 1-31, 2008 is the enrollment period for medical, dental, Section 125, vision, cancer/specified disease, disability and voluntary term life.

Enrollment instructions for each plan:   Total reenrollment for medical, dental, vision, Section 125 sheltered premium only plan and district provided life, including new beneficiary designation is required for 2009.

 

Plan

To enroll or make changes in current coverage:

Medical

TRS-ActiveCare 1

TRS-ActiveCare 2

TRS-ActiveCare 3

1.  Complete TRS-ActiveCare enrollment form, in blue or black ink

 - To enroll in coverage, complete sections 1, 2, 3, 4, 5 (if electing dependent coverage), 7, 8 (if applicable), and 10.

 - To decline coverage, complete sections 1, 2 and 9

Be sure to sign and date the form.

2.  Complete scan sheet in pencil, including dependent information for anyone you want covered.  Be sure to sign and date the form.

*Dental

C-FB Dental Plan

QCD

*Complete scan sheet, including dependent information for anyone you want covered.  Waive coverage if you do not want dental.

Section 125

1.  Complete scan sheet to elect or decline premium only plan.

2.  Complete Section 125 election form to participate in medical reimbursement or dependent care accounts for 2009.

 

Vision

Complete scan sheet, including dependent information for anyone you want covered.  Waive coverage if you do not want vision coverage.

District provided life coverage for $20,000

List beneficiary on scan sheet, including relationship and address.  This designation replaces anyone previously listed as your beneficiary and you may list more than one person.  

 

Cancer

Complete AIG application in ink and return to benefits office by October 31. Current coverage will continue unless a change is made.

 

Disability plan

Meet with UNUM representative at your campus sometime during the month of October to complete paperwork.  Current coverage will continue unless a change is made.

 

MetLife

Complete MetLife application in ink and Statement of Health form for each employee and spouse applying for coverage and return to the benefits office by October 31. Statement of Health form is not required for dependent children.  Current coverage will continue unless a change is made.

 

 




 

 
 
 
 
 
 
 

 

 

 

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