Insurance Open Enrollment 2014
and New Insurance – Eligible Employees

Benefit Information June 1, 2014 to July 1, 2015

OPEN ENROLLMENT April 28-May 9, 2014 – You must complete forms to elect new coverage or continue your current coverage. Please see the Enrollment Forms Section below to identify which forms you will need to complete for your benefit elections.

NEW EMPLOYEES – Below you will find the information you need to make your benefit elections. Please review this information prior to your Orientation Meeting with Human Resources. Complete the Benefit Election form below and the Enrollment form for each type of benefit you elect, and bring the signed forms with you to your Orientation appointment.

PowerPoint Presentations from Benefit/Open Enrollment meetings

Please review the list of enrollment forms below and read the instructions to make sure you are completing all forms necessary to enroll in your benefit choices.

  • Benefit Election form – All Benefit-eligible employees must complete this form. Even if you do not wish to enroll in optional benefits, a basic life insurance policy is required coverage until further notice.
  • Cigna Medical/Dental Enrollment Form – NEW CARRIER* Anyone electing Medical or Dental insurance must complete this form – make sure you indicate either or both medical/dental coverage in Section B next to each person’s name.
  • EyeMed Enrollment form – NEW CARRIER* Anyone electing Vision insurance must complete this form.
  • The Hartford Enrollment form – NEW CARRIER* Anyone electing Long Term Disability (LTD) insurance must complete this form.
    • The Hartford Personal Health Application form – If you are electing LTD insurance for the first time or improving your coverage to a lower number of days of elimination, you must complete this form.
  • Mutual of Omaha Enrollment form – If you are enrolling in Supplemental Life for the first time, increasing the policy amount for yourself or spouse, or adding a new family member you must complete this form. If you wish to continue your current Life Insurance elections you do not need to complete this form.
    • Mutual of Omaha – Evidence of Insurability – If you are enrolling in Supplemental Life for the first time or increasing the policy amount for yourself or spouse, you must complete this form.

Cigna HealthCare

Cigna HealthCare provides our medical and dental insurance. The following documents will help you learn more about your coverage under Cigna Medical and Dental Plans. The enrollment forms are provided here and in the Enrollment Forms section above.

EyeMed provides our Vision insurance plan. The following documents will help you learn more about your coverage under the EyeMed Plan. The required enrollment form is provided here and in the Enrollment Forms section above.

The Hartford provides our Long Term Disability (LTD) insurance plan. The following documents will help you learn about your coverage options. The enrollment form is provided here and in the Enrollment Forms section above.

Mutual of Omaha provides Life Insurance for St. Charles Community College. The following documents will help you learn about your coverage options.

Enrollment Form – Complete to apply for Life Insurance for the first time, to add new dependents, and to increase coverage for yourself or your spouse.

Evidence of Insurability (EOI)

  • New Employees – Complete EOI if you are requesting insurance in excess of 5 times your annual salary or over $150,000. If you are insuring your spouse for more than 50% of your benefit or over $50,000 you must complete the EOI for your spouse.
  • Current participants – Complete the EOI if you are increasing the amount of coverage for yourself or your spouse during open enrollment

Voluntary Term Life and AD&D Insurance Benefits Summary and Rate Tables – This provides information about the rates and terms of your Life Insurance Benefits