2012-2013 OPEN ENROLLMENT FOR HEALTH BENEFITS

JUNE 1  - JUNE 20, 2012

FORMS

MEMO:    2012-2013 Open Enrollment Memo and Instructions (click to view/print)

2012-2013 Waiver Form (click to view/print)

This form must be completed if you'd like to waive all or some of your health benefits for the 2012-2013 school year.  This is an annual election and must be renewed each year.

VSP Enrollment Form/Change Form (click to view/print)

This form must be completed if you'd like to enroll or renew your enrollment for the 2012-2013 school year. (if you do not renew enrollment, your current VSP coverage will terminate on 7/1/12)

Horizon Enrollment/Change Form (click to view/print)

This form must be completed if you were waiving medical/prescription coverage in 2011-2012 but would like to enroll for 2012-2013, or if you would like to add/delete dependents, or if you would like to change plan types. If you currently have a "Family" plan but only have coverage for yourself and your spouse, please complete this form to transfer the new "2 Adults" plan.

Delta Dental Enrollment/Change Form 

This form must be completed if you were waiving dental coverage in 2011-2012 but would like to enroll for 2012-2013, or if you want to switch the type of dental plan you're in (Premier to Flagship/DeltaCare or vice versa).  There are two dental forms to choose from, depending on your negotiating group, so please be sure to complete the correct form.

1. Delta Dental Enrollment/Change Form - Group #7273-0002 (click to view/print)

For all employees except bus drivers, principals/administrators, building supervisors, BA and Superintendent.

2.  Delta Dental Enrollment/Change Form - Group #7273-0004 (click to view/print)

For bus drivers, principals/administrators, building supervisors, BA and Superintendent only.

NOTE:  Before switching to the Flagship/DeltaCare plan, you must locate a participating dentist and indicate their name and office ID number on your application.  Please be aware that there are only a limited number of Flagship/DeltaCare dentists in this area so before you switch plans you will need to do a dentist search at www.deltadentalnj.com, using the DeltaCare group of dentists.  Then you'll need to call the dental office to be sure they are accepting new patients

FSA Plan Information and Enrollment Forms (forms will be available on 6/4/12)

There will be a FSA information meeting on 6/1/12 at 3:30 pm at the LVMS for all benefit eligible employees. Forms will be available to view/print on 6/4/12.