New Employees: Enrollment Form
Existing Employees: Open Enrollment For Plan Year 22-23 is Closed
- If you need a reminder of the benefits you currently have, please review your most recent check stub. If you don't have access to a recent stub please contact extension 2787 to make inquiries on your benefit selections.
- Download and complete the form entitled Open Enrollment Form for the upcoming plan year which begins on the first of July.
Section 1 You may choose to keep them all the same or make changes to the coverages individually. (For NO changes with NO flex plans, you may simply reply to this email saying “No changes and NO Flex plan for Plan Year 22-23)
- If you are adding or deleting coverage in Section 1, complete the Change Form and include it with your enrollment form.
- If you want to add cancer or life insurances, please call 2787 to request an application.
Section 2 Participants must sign up for Flexible Spending Accounts (every year) or elect not to participate. This is never automatic.
Section 3 Return your signed Open Enrollment Form(s) to Benefits & Payroll through campus mail or email no sooner than May 2 and no later than May 27, 2022. Remember, by law we are not allowed to accept changes outside the Open Enrollment Period.
If you DO NOT want coverage, please flip to the second page, sign it and return it along with your page 1.
3. Email a saved and/or scanned copy to firstname.lastname@example.org or mail a paper form to
the Benefits Office. (forms must contain an orginal signature or an adobe e-sign)
Summary Check List:
⃝ Did you email a saved copy of your form? If not, it will likely be blank.
⃝ Did you include your saved add/delete form for changes?
⃝ Did you remember to sign up for a Medical or Dependent Flex Act?
⃝ Did you sign your form before scanning or e-sign before saving?
Important Open Enrollment Notices:
Grandfathered Health Plans The Mercer Health Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that the Mercer Health Plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
- Dependent Care $5,000 max for both parents or $2500 for one parent.
- Medical Spending $2850