Get Fairfax County Benefits Online Enrollment Form
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How to fill out the Fairfax County Benefits Online Enrollment Form online
The Fairfax County Benefits Online Enrollment Form is essential for new employees and those newly eligible for benefits to enroll in health, dental, and flexible spending account programs. This guide will provide clear and supportive step-by-step instructions to assist you in completing the form effectively.
Follow the steps to fill out the enrollment form online.
- Click the ‘Get Form’ button to download and open the Fairfax County Benefits Online Enrollment Form.
- Begin filling out the personal information section, including your name, social security or EIN number, department, address, home and work phone numbers, email address, and hire date.
- Indicate the reason you are submitting the form by selecting either 'I’m a new employee' or 'I wish to enroll, change or cancel my current enrollment due to an eligible qualifying event.'
- If applicable, provide details about any changes in marital status, number of dependents, or employment status. Mark the relevant qualifying event and include the date it occurred.
- Fill out the Medical and/or Dental Coverage section, choosing your desired plan, level of coverage, and the individuals who should be covered.
- Complete the Enrollment Information section for each person to be covered, ensuring to list their name, birthdate, and primary care physician details, if required.
- If you need to drop a dependent, complete the section indicating the dependent being removed and the reasons for the removal.
- Complete the Coordination of Benefits Information, providing details of any other health insurance that you, your spouse, or dependent children will continue to be covered by.
- Fill out the Flexible Spending Account Programs section, indicating your desired contribution amounts for the Medical Spending Account and Dependent Care Account.
- Sign and date the form at the bottom, certifying that all information provided is accurate.
- Submit the completed form to the Department of Human Resources at the specified address or fax number.
Start completing the Fairfax County Benefits Online Enrollment Form online today to secure your benefits.
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Yes, Fairfax County offers a tuition reimbursement program for its employees who want to further their education. This benefit encourages professional development and can cover various educational expenses. By utilizing the Fairfax County Benefits Online Enrollment Form, you can apply for tuition reimbursement and take a meaningful step toward enhancing your career.