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  NEW HAVEN BENEFITS 2011 - 2012
PLAN YEAR - (OCT 01, 2011 - SEPT 30th 2012
)

LEARN ABOUT YOUR BENEFITS!

Questions? Contact Human Resources.

We know benefits are important. That is why New Haven contributes a substantial amount (averaging $320/month) towards employee's healthcare costs in addition to providing all regular employees with a group life benefit (including AD&D and an Employee Assistance Program).

Find information here about these benefit options, how and when to enroll, and how to make changes. Understand how these benefits contribute significantly to your overall compensation at New Haven and to your peace of mind!.

For those electing coverage for healthcare or any voluntary benefits, recognize that you must sign up for your benefits PRIOR to your effective dates (and re-elect each September thereafter for the new plan year, effective October 1st). Simply download the election form and complete an application for each carrier with whom you wist to establish coverage. You are also welcome to schedule an appointment in HR and we will be happy to assist you.


WHEN CAN YOU ENROLL?

(1) At time of Hire, (2) At Open Enrollment,
(3) Due to a Change of Status

(COBRA Participants - see Below)


HOW TO ENROLL!

FOLLOW THESE THREE STEPS:

1. Choose the benefits on the Employee Election Form.
You must complete an Election Form, if eligible - even
if you are waiving coverage.


2. Determine the best benefit choices for you (and any eligible dependents) and enroll! Most forms are available on-line. Complete one form for each choice.

3. Complete and turn in enrollment forms to HR (for ALL selections) by enrollment deadlines. (Unsure? Check WHEN CAN YOU ENROLL for details).


Note:
In lieu of an electronic submission process, you may also fax your enrollment forms to 760-630-4030 or scan and email attachments to humres@newhavenyfs.org.
(Please ensure that you get a confirmation of receipt - all required forms must be
received to ensure processing).


Questions?
Contact Human Resources

COBRA PARTICIPANTS:
You will automatically be renewed at Open Enrollment with the acceptance of your new rates unless you notify our Third Party Administrator (InfiniSource) of desired changes. Those COBRA participants currently in a dental plan will be retained in the plan
closest to their prior election but with a new provider; however, a
new application will be required for changes between plans.
(For example, if you were in the PPO low, you will remain in the
POS low unless you complete an application indicating something
new)
. Question? You may call HR or email.


BENEFIT FORMS
(
1) Complete an Election Form
(Required to authorize choices/changes & payrolldeduction)l

Election Form (w formula)
or
Election Form to Print

(2) Review Medical Plans
(Note Choice on Election Form - choose 1)

UNITEDHEALTHCARE
(formerly PacifiCare)
OR
KAISER

Enrollment Forms

(3) Choose Dental (3 choices)
Dental Enrollment - Low/Hi
Dental Enrollment - HMO

(4) Vision
Vision Enrollment

(5) Pretax Options
Salary Redirection Agmt.
(Authorizes Pretax elections for Heathcare options AND other Pretax options, if elected)


(6) Retirement Account -
Individual account must be established first, may email broker directly.
403B ENROLLMENT EMAIL
SRA Agreement Form

(7) UNUM Voluntary Life & Voluntary AD&D
Enrollment Form (AfterTax)
Health Statement
Beneficiary Statement

(8) Voluntary Short Term

Disability Application (AfterTax
)


Helpful Hints

Take advantage of Automatic Deposit
and
eliminate time, expense, and/or possible delays
in receipt of your payroll,
(due to your failure to pickup checks on payday).

Utilize pretax options
- Flex spending accounts and/or retirement plans
(make your $ work for you.)

Use this paycheck calculator to view
your net pay based on changes you are considering.
Try paycheckcity.com

to help calculate changes and/or see
how adding benefits or changing taxes
affects your net pay.


Related FORMS

HEALTHCARE Misc
Kaiser Change Form
Kaiser Student Certification
PacifiCare Change Form
PacifiCare Student Certification


Dental Misc

Foster/StepChild

Flex Plan Reimbursements
FLEX PLAN REIMBURSEMENT

403B CHANGES
SRA Agreement Form

LIFE INSURANCE CHANGES
For Group Life:
Principal Beneficiary Statements
For Voluntary Life/AD&D
Unum Beneficiary Statements


Required NOTICES

Prescription Drug Medicare
Notice of Creditable Coverage

SPD
Summary Plan Description for Cafeteria Plan

Universal Availability
Notice - 403B