Open Enrollment

Below find resources for benefited employees and non-benefited employees for open enrollment. To read an informational sheet about open enrollment, click here.

All changes are effective May 1, 2010. All enrollment forms are due to Human Resources by April 14, 2010.

Voluntary Open Enrollment Meetings:

• April 5: 3:00-4:30 pm, Deery Center
• April 6: 2:00-3:00 pm, Board Room
• April 7: 1:00-2:00 pm, Board Room
• April 12: 9:00-10:00 am, Board Room
• April 12 1:00-2:00 pm, Board Room
• April 14: 9:00-10:00 am, Board Room

Information for Benefited Employees:

Health Insurance Information:
All employees need to fill out the enrollment form whether electing or waiving coverage by
April 14, 2010. Please follow the instructions below for the section appropriate for your situation.

Benefit Information:

• United Healthcare Medical Benefits At-A-Glance
• United Healthcare Provider Directory Search choose “Heritage Select Advantage” as the network from the drop down box
• United Healthcare Prescription Drug Benefits
• Prescription 90 Supply List
• Prescriptions with Special Rules
• United Healthcare Chiropractic Benefits
  

To enroll in health insurance, please open the United Healthcare Enrollment Form. Type your information on the form - making sure to follow these directions to complete your form:

1. Check box in Requested Action section at top-  “Enrollment Application”
   
2. Part A: - Complete all except for the Primary Care Physician (PCP)
   
3. Part B: - Complete if you are enrolling family members
   
4. Part C: - Complete only if you are also covered by another health insurance plan
   
5. Part D – Complete only if you are enrolled in Medicare (or someone that is covered is enrolled in Medicare)
   
6. Part E – Do Not Complete
7. Once you've completed the form. Print, then make sure to sign and date the form in Part F.
8. Turn your completed form in to Human Resources.

To waive health insurance, please open the United Healthcare Enrollment Form. Check the box in the upper right corner that reads "check to waive coverage". Type your name in section A, then print. Before turning your form in to Human Resources, please sign anywhere on the form.

Delta Dental Information:
Current participants will continue enrollment automatically and do NOT need to fill out an enrollment form. Complete an enrollment form ONLY if you are joining, canceling or changing your enrollment.

• Full-time Employees, Delta Dental Enrollment Form
  
  
• Summary of Covered Services and Benefits
• Assess Your Risk of Dental Disease
• Vision Discount with Dental Program
  

Flexible Spending Account Information:
The flexible spending enrollment form must be filled out each year for healthcare and dependent care flexible spending plans.

RD Drenkow Enrollment Form. Please follow these instructions to complete your form:

1. Print the enrollment form.
2. Fill out the top section for requested information.
3. Fill out the information in the box as applicable to your situation.
4. Fill out Option 1. Fill out information with 'Yes" if you would like a Healthcare Flexible Spending Account or check 'No'. When determining annual contribution, be sure to take your pay period election x 24 if hourly, x 12 if salaried
5. Check 'Yes' or 'No' for Dependent Care Benefit Account. If you checked 'Yes' fill out the other blanks. When determining annual contribution, be sure to take your pay period election x 24 if hourly, x 12 if salaried
6. Skip Option 3 and Additional Benefit sections.
7. Sign and date.
8. Read and complete Page 3.

Information for Non-Benefited Employees:

New Health & Dental Insurance Options:
We are pleased to offer health and dental insurance for employees not eligible (under 30 hours/week) for the employer-sponsored health and dental plans.

• Through the Cedar Valley Chamber of Commerce and PDCM Insurance, any employee can enroll in a limited medical plan. Two levels of coverage are offered. Learn more...
  
  
• Delta Dental also offers an individual dental plan for all employees.Part-time Employees, Delta Dental Enrollment Form

Medicaid and the Children’s Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families. Read more...