Get The Following Information Is Needed To Complete The Necessary Documentation For Open Enrollment

Completing the necessary documentation for open enrollment is an important step in managing your benefits. This guide offers a clear and structured approach to filling out the information required for the open enrollment transaction online.

Follow the steps to successfully complete your open enrollment documentation.

1. Press the ‘Get Form’ button to access the form and open it in your editing interface.
2. Fill out the 'Description of Transaction' section by selecting the appropriate option: New, Change, Add, Delete, Cancel, or FlexCash. Ensure you check the relevant box for the transactions applicable to you and your dependents.
3. Complete the 'Employee Information' section. Provide your first name, middle initial, last name, contact information, social security number, and Bronco number. Ensure that all details are accurate.
4. In the 'Dependents to be Enrolled/Deleted' section, provide the names, dates of birth, social security numbers, and relationships of any dependents you are adding or removing. If additional space is needed, use the reverse side of the form.
5. Select your preferred Medical Plan and Dental Plan by checking the appropriate boxes. Remember to indicate any specific medical group or physician selection if necessary.
6. If applicable, complete the FlexCash enrollment by specifying if you are opting for it instead of medical or dental coverage, and provide the required alternate coverage provider group details.
7. Finally, review your completed form for accuracy and completeness. After reviewing, provide your signature and the date in the designated areas.
8. Save your changes, then download, print, or share the completed form as necessary. Ensure the form is submitted to Human Resources by the specified due date.

Complete your open enrollment documents online today to ensure your benefits are accurately updated.