Medical Benefit Options
Important Notes About Your Medical Benefit Options:
The rates shown are based on the employees and dependents expected to enroll in coverage. Final rates may be adjusted based on the actual number of members who enroll.
The insurance carrier also has requirements for which plans can be offered. If there is not enough enrollment interest in a specific plan, that plan may not be available. If this happens, your plan administrator will contact you and explain your available options.
Rates are based on each person enrolling in the plan. For example, family coverage may vary depending on the number of children enrolled. This may be different from how your previous carrier calculated rates.
When you click the Medical Benefit Options button, you will be able to compare the available plans side-by-side. You can also select the PDF icon to view plan details and use the Search link to look up providers.
Enrolling in Medical Benefits
Complete this form to confirm your medical plan selection and map your current medical enrollment to the new plan option.
This form is intended for employees who are keeping the same coverage structure they currently have. If you need to make a change to your current enrollment — such as adding or removing a dependent, changing your coverage tier, updating personal information, or making any other enrollment change — please contact your plan administrator directly before submitting this form.
Waiving Medical Benefits
If you do not want to enroll in medical benefits, please complete the waiver form by clicking the button below.
By waiving coverage, you are confirming that you are choosing not to enroll in the medical plan offered through your employer at this time. If you have questions about waiving coverage, or if you are unsure whether you should enroll or waive, please contact your plan administrator before completing the waiver.