QUICK FORMS

• Required Open Enrollment Form
  Enrollment Form
  
  
• AFLAC
  Enrollment Form
  
  
• Enrollment/Change Forms
  Health , Delta Dental , and Avesis .
  
  
• Life Insurance
  Change of Beneficiary
  
  
• Select 2009 Summary and Plan Rates 2012-13
  Certified Summary
  

WHAT CHANGES CAN YOU MAKE?

New Enrollment - If you are not currently enrolled in a particular plan but would like to be, this is your chance to do so without having an employment status change or without having a change in family status.

Changes you can make, which would otherwise require a qualifying event, include:

1. switch from a single to a family policy by adding a spouse and/or children
2. add dependents to an existing family policy
3. switch from a family policy to a single policy

HOW DO I TAKE ADVANTAGE OF OPEN ENROLLMENT FOR HEALTH,
DENTAL OR VISION COVERAGE?

To take advantage, complete the online form. If enrollment/changes were selected, print and fill out the appropriate enrollment form (see above).

Return the completed, signed form to Sandy Ely at CEC. Watch for your new insurance cards in the mail.

If you have questions, please feel free to contact Sandy Ely at 957-3430 or sandy.ely@southeastpolk.org at CEC.

OFFERED PLANS

• Health Insurance Southeast Polk offers health insurance through First Administrators.  You are eligible for the Select First 2009 plan.  You may find more detailed information on this plan on the district website Select First Plan 2009 Summary .  Vision exams will remain covered under the health insurance. 

• Dental Insurance Southeast Polk offers dental insurance through Delta Dental.  There are no co-pays for regular check-ups and cleanings.  Coinsurance for all other procedures is either 80% or 50% with a $1,000 benefit period maximum.

• Vision Insurance Southeast Polk offers vision insurance through Avesis.  This insurance covers hardware (glasses and contacts) only.  It is an approximate $150 benefit per participant per year.

Select 2009 Summary and Plan Rates 2012-13        

Review the summary for the Select First 2009 plan and rates for all plans. -  Certified Summary

HEALTHCARE REFORM DISCLOSURES

Review the Southeast Polk Community School District Healthcare Reform Disclosures for the Select First 2009 Plan.

MENTAL HEALTH NOTICES

Review the Southeast Polk Community School District Mental Health Notice .

LIFE INSURANCE

Periodically it is good to review and update your life insurance form beneficiaries.  Please click and print the Change of Beneficiary form. Return completed form to Sandy Ely at CEC. Contact Sandy at 957-3430 or sandy.ely@southeastpolk.org if questions.

TASC
(FLEXIBLE SPENDING ACCOUNTS FOR UNREIMBURSED MEDICAL AND DEPENDENT CARE )

Reference the district website for additional information on flex benefits.  Remember, the district plan offers the flexibility of using the FlexSystem Claim Card for payment of co-pays and deductibles should you choose to use it.  MyCash, direct deposit, and online tools are also available for ease in requesting and receiving reimbursements in a timely manner.  Once enrolled, you will receive a log in ID and PIN.

Please use care when making your annual election.  Changes will not be allowed once the plan year begins.  If you elect to participate, you will receive written notification around the middle of July from TASC confirming the annual election amounts from TASC.  If you elect to participate and DO NOT receive confirmation, or note a discrepancy in the amount(s), please notify Sandy.

AFLAC INSURANCE

AFLAC - Aflac is offering new plans during our 2012-13 open enrollment.  Your school office will have packets and applications available for all employees. Application and additional information are available on the SEP Insurance website. If you any questions please contact Christina Paterson at 515-957-3430.