Health Benefit Enrollment Application

The HB enrollment application must be completed for initial enrollment into the benefit or when making a change to your coverage during the annual open enrollment or because of a qualified change in status.

This form must be signed and submitted to the health benefit department for review.  Completion of the form does not provide you with a benefit.  Once the request has been reviewed, a notice of confirmation will be sent to you.  If there are any questions regarding your eligibility to make a change or enroll, the health benefit department will contact you directly to discuss. 

PDF of the application: Health Benefit Enrollment Application
 

Postponement of Coverage

If you or your spouse are employed and have other valid health plan coverage through an employer, you may elect to postpone your coverage under this group Health Benefit until you no longer have other health plan coverage.  If you elect to postpone coverage for yourself, coverage for your dependents will also be postponed. 

PDF of the request to postpone initial enrollment into the plan: Request to Postpone Coverage

Suspension of Coverage

If you are covered under the plan, you may elect to suspend your coverage if you obtain other valid health plan coverage through an employer.  You may suspend your plan coverage at any time provided your change is a qualified change in status. 

PDF of the request to suspend health plan coverage: Request to Suspend Coverage




For further details regarding anything mentioned on this page, please refer to the Health Benefit Handbook