Get Enrollment Form For 2010 Benefit Elections To ... - Purdue University - Purdue

Completing the enrollment form for 2010 benefit elections is essential for accessing the appropriate benefits at Purdue University. This guide provides clear, step-by-step instructions to help you navigate each section of the form confidently and accurately.

Follow the steps to complete your enrollment form effectively.

1. Press the ‘Get Form’ button to access the enrollment form and open it in your editor of choice.
2. Begin by entering your name in the designated field to identify yourself as the applicant.
3. Fill in your department, campus address, and unique identifiers such as your PUID and PRNR accurately.
4. Review the 2010 Enrollment Reference Guide to understand the available benefit options and corresponding pricing.
5. Indicate your benefit elections for 2010, starting with the medical plan you wish to enroll in and specifying your coverage category.
6. If applicable, provide your spouse's name and PUID, ensuring you follow the correct instruction for selecting contribution tiers.
7. For those participating in the Purdue Choice Fund, complete the sections related to the Health Savings Account and the Limited Purpose Health Care Flexible Spending Account, specifying your desired contributions.
8. Choose your coverage category from the options provided, ensuring to update any changes to dependents on the back of the form.
9. Select your preference for short-term disability coverage if you are a biweekly-paid employee and indicate any additional accidental death and dismemberment coverage amounts.
10. Complete the Health Care and Dependent Care Flexible Spending Account sections by entering the annual amounts you wish to contribute.
11. List any dependents you wish to add, providing proof of their eligibility for coverage as required, and ensure to follow the guidelines for dropping dependents.
12. Review and sign the form to certify your choices, making sure to date the document.
13. Submit your completed enrollment form to Staff Benefits by the deadline of November 13, 2009, ensuring that all fields are accurately filled to avoid delays.

Complete your enrollment form online today to ensure you receive the benefits you need!