Get Benefit Selection Form - Clackamas County - Clackamas

The Benefit Selection Form for Clackamas County allows users to select their preferred benefits for the upcoming year. By following these straightforward steps, you can efficiently complete the form online, ensuring you choose the best coverage for your needs.

Follow the steps to successfully complete the Benefit Selection Form.

1. Press the ‘Get Form’ button to access the Benefit Selection Form and open it in your preferred editing tool.
2. Begin by indicating your enrollment type. If you are a new enrollee or are making changes due to a family status update, check the appropriate box.
3. Review the medical plans and their monthly costs listed in the form. Select your preferred plan by checking the box next to the option that fits your needs—options include Providence Personal Option, Providence Open Option, and several Kaiser and MODA plans.
4. If applicable, you can choose your dental plans and additional life insurance options. Make your selections based on the coverage offered and monthly premiums outlined.
5. For disability insurance, review the details provided and select your desired coverage based on your salary circumstances.
6. Read the authorization section carefully. This section confirms your understanding of the deductions that will occur from your paycheck for your selected plans.
7. Sign and date the form to finalize your selections. Ensure that all information is correct before submitting.
8. Finally, you may save changes, download a copy, print the form, or share it as needed.

Complete your Benefit Selection Form online today to ensure you have the right coverage for the upcoming plan year.