Get Open Enrollment Change

Filling out the Open Enrollment Change form is an essential process for making adjustments to your health insurance coverage. This guide will provide you with a clear and structured approach to ensure that your form is completed accurately and efficiently.

Follow the steps to complete the Open Enrollment Change form effectively.

1. Press the ‘Get Form’ button to access the Open Enrollment Change document and open it in your editor.
2. Enter your employee information in the designated fields. This includes your name, department, mailstop, email address, and extension. Ensure all information is printed clearly.
3. Select your employment status by checking the appropriate box. You will find various options such as Non-Exempt staff, Faculty, and Affiliates. Choose the one that applies to you.
4. Identify your pay cycle. Options include Weekly, Semi-Monthly, or specific union-related pay cycles. Check the box corresponding to your situation.
5. Review the Medical Insurance Coverage section. Select your current medical plan and your new medical plan effective January 1, 2011 by checking the appropriate boxes.
6. Indicate your current membership coverage and new membership coverage for the medical plan. Choose from options such as Individual or Family. If applicable, select the option to add child(ren) to existing family coverage.
7. Proceed to the Dental Insurance section. Check your current dental plan and select your new dental coverage effective January 1, 2011, also by checking the relevant boxes.
8. Complete the current membership and new membership coverage for dental plans similarly. Ensure that all selections reflect your desired coverage changes.
9. Once all information is filled out accurately, save your changes to the document. You may then choose to download, print, or share the completed form as needed.

Complete your Open Enrollment Change form online today to ensure your benefits are updated in time.