2021 Open Enrollment Materials

Below is the complete list of 2021 Open Enrollment materials.

Active Clergy/Active TAC Fiscal Office Lay Employees

 

Document

What it's for...

 1

2021  Active Employee OE Letter

2021 group health highlights for active clergy and TAC Fiscal Office lay employees

 2

2021 OE Instructions

Active clergy and TAC Fiscal Office lay employee open enrollment instructions

 3

2021 Overview of Changes

What's changing in 2021 for active clergy and TAC Fiscal Office lay employees

 4

2021 Group Health Enrollment Form

Submit enrollment form only if making changes in your plan elections or dependent coverages in 2021

 5

 

2021 Boon-Chapman Annual Additional Insurance Form (required each year for enrolled dependents)

Must be submitted by January 1 each year or dependent benefits are limited to $1,000 until completed form is received.

 6

Humana Dental/Vision Plan Summary 

Comparison of plans, premiums and enrollment instructions

 7

Humana Dental HMO Plan

Overview of plan details

 8

Humana Dental PPO Plan

Overview of plan details

 9

Humana Vision 130 Plan

Overview of plan details

10

Welcome to RxBenefits~Express Scripts

RxBenefits~Express Scripts Introduction

11

RxBenefits~Express Scripts Prescription Benefit Coverage Summary

Overview of prescription drug plan

12

Live Well, Work Well:  ER or Urgent Care?

Guidelines for treatment at the ER or Urgent Care Center

13

High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA)

Understanding HDHP plans and setting up a tax-advantaged HSA

14

Teladoc®

Overview of plan details

 

Government Required Notices

Required legal notices

15

2021 Standard PPO Plan Summary of Benefits and Coverage

Your Standard PPO Plan benefits in health care reform standard format

16

2021 High Deductible Health Plan Summary of Benefits and Coverage

Your HDHP benefits in health care reform standard format

17

HIPAA Privacy Notice

Protection of your personal health information

 

18

Medicaid and CHIP Premium Assistance Notice

Assistance to help pay for your employer group health plan coverage if you or your children are eligible for Medicaid or CHIP

19

Newborns’ and Mothers’ Health Protection Act Notice

Mother and new baby benefit information

20

Women’s Health and Cancer Rights Act Notice

Women’s health and cancer benefit information

21

Medicare Part D Creditable Coverage Notice

Your prescription drug benefit compared to Medicare Part D

22 

TAC Wellness Program Notice

Wellness program information

Under 65 Early Retirees / Under 65 Spouses of Medicare Primary Participants / Under 65 Surviving Spouses

 

Document

What it's for...

 

 1

 

2021 Open Enrollment Letter

2021 group health highlights for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses

 2

2021 OE Instructions

2021 enrollment information and instructions for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses

 3

2021 Overview of Changes

What's changing in 2021 for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses

 4

2021 Group Health Enrollment Form

Enrollment form for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses who want to change plan elections

 5

2021 Boon-Chapman Annual Additional Insurance Form

Must be submitted by January 1 each year or dependent benefits are limited to $1,000 until completed form is received

 

All documents numbered 6 – 22 above pertain to under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses

Additional 2021 OE documents

 

Benefits Disclaimer         About Your Benefits