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  • Benefits Enrollment Form

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Health and Welfare Benefits Enrollment Form Please print clearly and provide complete and accurate information. Personal Information SECTION Employee Name (First MI Last) SSN Date of Birth Home Address.

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Follow this step-by-step guide to make your Benefits Enrollment Form:

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What is open enrollment for benefits? In the U.S., open enrollment season is a period of time when employees may elect or change the benefit options available through their employer, such as health, dental and life insurance, and ancillary or voluntary benefits ranging from legal services to pet insurance.

All Section 125 cafeteria plan elections for health and welfare benefits can be handled via a passive enrollment. That includes medical, dental, vision, health FSA, dependent care FSA, and HSA elections.

An active enrollment requires employees to decide and choose a benefits selection each enrollment period—as opposed to passive enrollment, where employees are automatically re-enrolled in their current selection, with little or no involvement in the process.

Passive enrollment—also known as auto-enrollment—is a benefits enrollment strategy used by employers to simplify the process and maintain consistent benefits participation. Employers using a passive benefits enrollment approach simply roll over each employee's benefit elections from the previous enrollment period.

SF 2810, Notice of Change in Health Benefits Enrollment.

Passive events are jobs that run in the background to automate benefit events. Examples include dependents aging out, automatic benefit group eligibility check, 401(k) auto-enrollment and ACA eligibility checks.

Passive enrollment is exactly what it sounds like—passive. Just like passive income is income that you don't need to actively work to acquire, passive enrollment allows employees' benefits to remain the same year after year without them having to participate in the opt-in process.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232