Get Benefits Continuation Election Form

This guide provides clear and detailed instructions for completing the Benefits Continuation Election Form online, ensuring you understand each step and requirement. By following this guide, you can effectively manage your benefits during your leave of absence.

Follow the steps to complete the Benefits Continuation Election Form online:

1. Select the ‘Get Form’ button to access the Benefits Continuation Election Form and open it for editing.
2. Begin by entering the employee's name in the designated field, ensuring it matches the name on official records.
3. Input your employee payroll number, which is a five-digit code assigned to you.
4. Fill in your position title accurately to reflect your current role within the organization.
5. Specify your department by listing the official name of the department you work in.
6. Indicate the type of leave you are requesting by checking each applicable box, including FMLA/Medical, Military, and Worker’s Compensation.
7. Provide the reason for your requested leave and the start date, along with the last date worked and the expected return to work date.
8. For short term disability (STD) and long term disability (LTD), select whether you are claiming STD or waiving it, and provide any necessary additional information.
9. Choose your preferred payment method for approved STD pay: unpaid, partially paid with specific hours, or fully paid using accrued leave.
10. Review your benefit elections, confirming whether you want to continue your health insurance, dental insurance, vision insurance, life insurance, and deferred compensation.
11. Indicate your payment election method, selecting between payroll deduction or monthly direct pay.
12. Read through the acknowledgement statements. You must understand your responsibilities regarding benefit payments and conditions during your leave.
13. Sign and date the form to validate your selections and understanding of the terms.
14. Finally, save your changes, and choose to download, print, or share the completed form as necessary.

Complete your Benefits Continuation Election Form online today to ensure your benefits are managed efficiently during your leave.