Open Enrollment


OPEN ENROLLMENT IS MAY 1, 2022 TO MAY 25, 2022!

ALL ENROLLMENT FORMS/CHANGES MUST BE RECEIVED BY JODI WICK, HUMAN RESOURCE ASSISTANT, NO LATER THAN MAY 25, 2022.  IF YOU HAVE ANY QUESTIONS PLEASE EMAIL HER AT [email protected]

The open enrollment period for 2022-2023 benefit elections has begun for all benefit eligible staff.  This is the only time you can make voluntary changes to your medical and/or dental plans for 2022-2023 without a change in life status such as marriage, death, adoption, spouse's job loss, etc.

If you do not want to make any changes to your health or dental plan, no action is required on your part.

This is also the only time you can enroll in a Flexible Spending Account for 2022-2023 (Healthcare Flexible Spending Account and/or Dependent Care Flexible Spending Account).  Please note your 2021-2022 Flexible Spending Account will not roll over to 2022-2023.  You will need to complete a new enrollment form if you want to continue with your Flexible Spending Account.

If you are enrolled in the Lumenos health plan you will want to complete the form entitled FSA Enrollment Form LIMITED PURPOSE and if you are enrolled in the Access Blue New England health plan you will want to complete the form entitled FSA Enrollment Form.  Please note the forms are district specific.
 
FSA/Dependent Care Enrollment Forms:
Greenland FSA Enrollment Form
Greenland FSA Enrollment Form LIMITED PURPOSE
Rye FSA Enrollment Form
Rye FSA Enrollment Form LIMITED PURPOSE
Newington FSA Enrollment Form
Newington FSA Enrollment Form LIMITED PURPOSE
New Castle FSA Enrollment Form
New Castle FSA Enrollment Form LIMITED PURPOSE
SAU 50 Central Office FSA Enrollment Form

Health Insurance Plan Comparisons:
Teachers - Greenland, New Castle, Newington & Rye
Support Staff - Greenland & Newington
Support Staff - Rye and SAU 50
Support Staff - New Castle

Summary of Benefit Coverages (SBC)
AB$5 10/25/40-10/40/70
AB$20 10/25/40-10/40/70
AB$20 10/20/45
Lumenos



Dental Plan Benefit Summaries:
Option 1 - Greenland & Rye
Option 2 A - New Castle
Option 3D - SAU 50
Option 4 - Rye
Option 4A - Greenland
Option 6A - Newington


Health and/or Dental Enrollment Form:
Enrollment Form
Helpful Hints When Completing Medical and/or Dental Enrollment Form


Retiree Forms/Information
HealthTrust Retiree Video (click link below)
https://healthtrustnh.wistia.com/medias/7k3egpjsd0

Medicomp III
Medicomp III Prescription Drug Program
Retiree Medical and/or Dental Enrollment Form
Retiree Annuity Deduction Authorization Form
Helpful Hints When Completing Retiree Medical and/or Dental Enrollment Form

Mandatory Notices
Primary Care Provider (PCP or Ob/Gyn Provider Selection
Premium Assistance under Medicaid and the Children's Health Insurance Program (CHIP)

Distribution Requirements for Summary of Benefits and Coverage (SBC)
It is required that I make available all the uniform Summary of Benefits and Coverages (SBC).
AB$5 RX10.25.40-10.40.70
AB$20 RX10.25.40-10.40.70
AB$20 RX10.20.45
Lumenos

 

ALL ENROLLMENT FORMS/CHANGES MUST BE RECEIVED BY JODI WICK, HUMAN RESOURCE ASSISTANT NO LATER THAN MAY 25, 2022. IF YOU HAVE ANY QUESTIONS PLEASE EMAIL HER AT [email protected]

 


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