Open enrollment

Your benefits

Review your options, price them against your own classification, then produce a signed election summary to keep and to send to Human Resources.

1

Review

Start here: your employment classification

Rates and eligibility depend on how you are classified. Choosing here updates every rate on this page.

Employment classification

Reason for enrolling

2

Elect

Complete every section. Choose Waive for any coverage you do not want. Your monthly cost updates at the bottom of the screen as you go.

First name

Required

Last name

Required

Employee ID

Required

Work email

Required

Department or division Position Hire date

Add a row for each dependent included in any election above. Leave blank if you are enrolling only yourself.

3

Review and sign

Type your full name to sign

Must match the first and last name you entered above.

Signature must match your name

Date signed

4

Submit

Download a copy for your records, then submit. Your submission is delivered to the benefits administrator for review.