Step
1 - Election
Form
Print
out or complete
on computer (will add for you), selecting benefits
you wish to elect for yourself and/or your dependents.
SIGN & Date.
Step
2 - For Medical coverage, complete
either the Kaiser
Enrollment Form or the Pacificare
Enrollment Form (Your plan choice, Low or
High, is indicated on your election form).
If you are adding or deleting a dependent
or changing plans from High to Low or Low to High,
complete the Change
Form.
Step
3 - For
Dental coverage, complete Golden West's
Dental
Enrollment Form.
(Your
plan choice, PrePaid, Low or High is indicated
on your election form)
If you are adding or deleting a dependent or changing
plan, use this Change
Form.
Step
4 - Vision Coverage. Don't be confused,
this is also through Pacificare and while the
form is multi-purpose, this Enrollment
Form is only for Vision Coverage.
Step
5 - Salary
Redirection Agreement Form. All who pick anything
in steps 2 - 4 must complete and sign to acknowledge
that their costs will come out before tax is calculated.
Step
6 - The Salary
Redirection Agreement is also used to elect
URM or Dependent Care Accounts (a pretax benefit). Learn more about how this options saves you tax dollars when you accurately estimate your expenses over our plan year.
Step
7 - Life and/or AD&D Insurance.
Use this Enrollment
Form to select Life Insurance Benefits. If
you are picking over $60K or have not previously
elected and are NOT a new hire, you must also
complete an Evidence
of Insurability Form.
Step
8 & 9 - To enroll in a 403B or
Roth IRA and/or to consider additional Short Term Disability
benefits for an additional premium based on your salary - see HR or email
our broker. Disability benefits require an application and are subject to approval.
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