- Opt Out Incentive (must be renewed annually)
- HSA contribution (must be renewed annually)
- Use this form to make changes outside of open enrollment: HSA Change Form
- Contact the Benefits Office for:
- Life insurance claim
- Waiver of Premium application
- Notice of Conversion / Portability (to request a quote when you are leaving employment or losing coverage)
- Beneficiary Designation
- If you are married and designating someone other than your spouse as a primary beneficiary, contact the Benefits Office
Long Term Disability
- Claims for Disabilities that began July 1, 2015 or later
- Claims for Disabilities that began July 1, 2009 - June 30, 2015
- Claims for Disabilities that began prior to July 1, 2009
- Cancel medical/dental/vision (retirees only)
- Drop your Dependent from medical/dental/vision (retirees only)
Retiree Dental & Vision require continuous coverage. Dropping coverage may prevent you from re-joining.
Dependents of age 65+ retirees may not rejoin Medical once coverage is waived.
Visit the Insurance Handbook for details.
Flexible Spending Account
- Visit www.asiflex.com