2023 Open Enrollment (OE) Materials

Below is the complete list of 2023 Open Enrollment materials.

Active Clergy / Active TAC Fiscal Office Lay Employees

 

Document

What it's for...

 1.

 

2023 Active Clergy / Active TAC Fiscal Office Lay Employee Open Enrollment (OE) Packet

 

2023 Open Enrollment Packet mailed to all active clergy and TAC Fiscal Office lay employees

 2.

2023 Active Employee OE Letter

2023 Group Health Plan highlights for active employees

 3.

2023 Active OE Instructions

Open Enrollment instructions for active employees

 4.

2023 Active OE Overview of Changes

What's changing in 2023 for active employees

 5.

2023 Active Group Health Benefits Enrollment Form (blue and white 2-page form)

Active employees submit GHB Enrollment Form during Open Enrollment only if making changes to your coverage in 2023

 6.

2023 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.

 7.

2023 Humana Dental PPO and Vision Plan Benefit Summary

Description of Dental PPO and Vision plans, premiums and enrollment instructions

 8.

2023 Humana Dental PPO Plan Brochure

Overview of Dental PPO plan details

 9.

2023 Humana Vision 130 Plan Brochure

Overview of Vision plan details

10.

RxBenefits~Express Scripts Prescription Benefit Coverage Summary

Overview of Prescription Drug plan

11.

2023 Express Scripts National Preferred Formulary (Abridged with Exclusions)

Abbreviated drug list of most commonly prescribed medications and exclusions

12.

2023 High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA)

Understanding HDHP plans and setting up a tax-advantaged HSA

13.

Teladoc®

Overview of telemedicine benefit

14.

Live Well, Work Well:  ER or Urgent Care?

Guidelines for treatment at the ER or Urgent Care Center

15.

2023 Standard PPO Plan Summary of Benefits and Coverage

Your Standard PPO Plan benefits in health care reform standard format

16.

2023 High Deductible Health Plan Summary of Benefits and Coverage

Your HDHP benefits in health care reform standard format

17.

2023 Required Annual Notices

Government required annual notices for GHB plan participants

Under 65 (U65) Early Retirees / Under 65 (U65) Spouses of Medicare Primary Participants / Under 65 (U65) Surviving Spouses / Under 65 (U65) Other Dependents of Medicare Primary Participants

 

Document

What it's for...

 1.

2023 U65 Retiree / Spouse / Surviving Spouse / Other Dependents of Medicare Primary Participants Open Enrollment Packet

2023 U65 Open Enrollment Packet mailed to all under age 65 (U65) early retirees, spouses and other dependents of Medicare Primary participants, and surviving spouses

 2.

2023 U65 Open Enrollment Cover Letter

2023 Group Health Plan highlights for U65 participants

 3.

2023 U65 OE Instructions

2023 Open Enrollment instructions for U65 participants

 4.

2023 U65 Overview of Changes

What's changing in 2023 for U65 participants

 5.

2023 U65 Group Health Open Enrollment Form (green and white 2-page form)

U65 participants submit U65 GHB Open Enrollment form only if making changes to your coverage in 2023

6.

2023 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.

 7.

 –   17.

All documents numbered 7 – 17 above pertain to under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses

Additional 2023 OE documents for review: documents numbered 7 – 17 above

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