CityOfPomonawithGoddess
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Open Enrollment 2017

Annual Open Enrollment 2017

Benefits are important; they provide support to you when you need it the most. Getting the most value from your benefits depends on how well you understand your plans and how you use them. Make it a point during the City’s open enrollment period to review your family’s changing needs, evaluate your existing coverage and decide whether to continue with your current choices or make a change. Use the many resources available to make well-informed decisions about your benefits for the coming year. Being proactive now will ensure that you and your family have the coverage you need throughout the year ahead.

 

Do You Need to Do Anything?

• The answer is yes!  Please read below for items you may need to take action on:

• All employees – complete and return a Cafeteria Plan Election Worksheet and Emergency Contact Form. A customized worksheet with your current elections and a blank emergency contact form will be distributed on 9/14/17 along with your check stub. If you do not receive these forms, or have misplaced them, you may request a duplicate from Human Resources or you may print a blank form from the forms listed below.

• Employees enrolled in the cash-in-lieu program - complete and return a Waiver of Coverage Form with proof of your alternative group health coverage.

• Employees making changes to their coverage - complete and return the applicable forms available below.

• Employees electing Flexible Spending - complete and return the application forms available below.  You must enroll for this benefit every year;  your election does not carry over to the following year.

• Keep in mind that after the Open Enrollment period, you cannot change your benefit elections during the year unless you have a qualifying life event.

 

Important Dates

This year’s Open Enrollment period will take place as follows:

  • Medical, dental, vision, cafeteria plan: September 11, 2017 through October 6, 2017
  • Flexible spending, Aflac, additional life insurance: September 11, 2017 through October 31, 2017.
  • Aflac representatives will be available throughout open enrollment to help you with your Aflac ancillary benefit enrollment, please click here for the schedule.

The benefits you elect during open enrollment will go into effect January 1, 2018. Keep in mind that after the Open Enrollment period, you cannot change your benefit elections during the year unless you have a qualifying life event.

 

What Should You Know Before You Enroll?

Before you make any decisions, take a moment to read the material in this enrollment guide:

Open Enrollment Guide pdf icon

 

It is also important to be up to date on your rights and responsibilities regarding benefits. Please read these important benefit notices:

Annual Benefit Notices pdf icon

 

 

Forms

Emergency Contact Form:

Emergency Contact Form pdf icon

Cafeteria Plan:

Cafeteria Election Worksheet pdf icon

Medical:

HBD12 Health Benefit Plan Enrollment pdf icon

HBD12A Health Declaration pdf icon

Waiver Coverage Form pdf icon

Dental and Vision:

Dental and Vision Form pdf icon

Life Insurance:

Standard Life Disability Enrollment Form pdf icon

Standard Medical History Statement pdf icon

Flexible Spending Accounts (Health and Department Care):

TAG Flexible Spending Enrollment Form pdf icon

 

 

 

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