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 Group Health Plan highlights for active employees |
|
|
3. |
Open Enrollment instructions for active employees |
|
|
4. |
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. |
Description of Dental PPO and Vision plans, premiums and enrollment instructions |
|
|
8. |
Overview of Dental PPO plan details |
|
|
9. |
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. |
Overview of telemedicine benefit |
|
|
14. |
Guidelines for treatment at the ER or Urgent Care Center |
|
|
15. |
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. |
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 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 Group Health Plan highlights for U65 participants |
|
|
3. |
2023 Open Enrollment instructions for U65 participants |
|
|
4. |
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. |
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 |