Open Enrollment Guide

Open Enrollment Guide for Plan Year 2020

Open enrollment begins Tuesday, October 29, 2019 and ends Friday, November 8, 2019. All changes made during this time period will be effective beginning January 1, 2020. This is your only opportunity to make changes to your benefits unless you experience a qualifying event prior to the open enrollment period in October of 2020 for the 2021 plan year.

Please refer to the guidelines below for what needs to be completed during open enrollment. All forms are located on the ENSUVT.ORG  website and are linked into this guide. If you need help accessing a form, please ask for assistance printing the form from the website. You must turn your forms into central office NO LATER than FRIDAY, NOVEMBER 8, 2019.

 

Please follow the guideline that best suits your needs:

 

FSA 

 

  • I do NOT want to make any changes to my current FSA benefit plans:
    • Complete the HealthEquity FSA Enrollment/Decline form
      •  You will need to fill out the top section with your personal information.
      • If you are choosing to participate, please check the box indicating this and enter your total annual amount.
        • Please indicate that you are opting for both the debit card and direct deposit (it may be processed either way).
        • Please print your name, sign and date at the bottom-most line.
      • If you are choosing NOT to participate, simply print your name, sign and date bottom-most line and check the ‘I decline to participate in the FSA plan’ box.

 

  • I want to make changes to my current FSA benefit plans:
    • Complete the HealthEquity FSA Enrollment/Decline form
      •  You will need to fill out the top section with your personal information.
      • If you are choosing to participate, please check the box indicating this and enter your total annual amount.
        • Please indicate that you are opting both the debit card and direct deposit (it may be processed either way).
        • Please print your name, sign and date at the bottom-most line.
      • If you are choosing NOT to participate, simply print your name, sign and date bottom-most line and check the ‘I decline to participate in the FSA plan’ box.

 

 Healthcare

 

  • I want to continue to refuse a Health Plan, I will need to complete the Health Insurance Enrollment Form.
    • To fill out the Health Insurance Enrollment Form:
      • Fill out personal information in section 1.
      • Check the box indicating ‘refusal’ in section 2.
      • Sign in section 6.

 

  • I’m a current member of the Health Plan, I do not want to make any changes for Plan Year 2020.
    • No form to complete – Your current plan will continue

 

  • I'm a current member, I want to make changes, enroll, or cancel my Health Plan, I will need to complete the Health Insurance Enrollment Form.
    • To fill out the Health Insurance Enrollment Form:
      • Fill out all personal information and new plan election in section 1.
      • Check the box indicating open enrollment in section 2.
        • If you are choosing to cancel your coverage at this time, please check voluntary cancellation in section 3.
      • Dependents you are adding or removing in section 4.
      • List secondary coverages, if any, in section 5.
      • Sign in section 6.

 

If you have questions about forms or what you need for open enrollment, please contact:

 

Christi Rancourt

This email address is being protected from spambots. You need JavaScript enabled to view it.

802.266.3330 x201