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Open Enrollment


, CT  06470




DATE:         May 13, 2013
TO:              Eligible Employee
FROM:        Denise Hornyak, Insurance Coordinator
SUBJECT:  Medical/Dental Insurance – Open Enrollment
                    Response Required by June 7

Open enrollment will occur between May 13 and June 7 this year for medical and/or dental insurance coverage that will begin on July 1.  You will have the opportunity to enroll for the first time, make a change to your current election, add or cancel dependents, or waive the insurance during that period only.  After this, the next open enrollment period will not occur until May/June 2014 for plan coverage during 2014-15.  Changes outside the open enrollment period are only permitted if a qualified change in family status has occurred.


As of July 1, 2013 the teacher’s Anthem medical insurance coverage will change from the PPO20 to the PPO30 and the Administrator’s insurance coverage will change from the PPO25/30 to the Comp Mix. 

  • All teachers currently enrolled in the PPO20 will automatically be enrolled in the Century Preferred PPO 30 Plan.
  • If you do not want to be automatically transferred, and choose to enroll in the HSA for the first time, you must complete an Anthem enrollment form, and if desired a HSA Payroll Deduction Form.  (For employees currently contributing to a Flex Medical Account, please refer to additional information provided on the website regarding IRS regulations for HSA and Flex Medical Accounts).     
  • All Administrators currently enrolled in the PPO25/30 will automatically be enrolled in the Century Preferred Comp Mix. 


You must complete an Anthem application for health insurance and a Dental application for coverage if you are enrolling for the first time or adding a dependent to either or both insurances.  The following information must be submitted along with the membership application:

RELATIONSHIP                                                                   DOCUMENT REQUIRED

Spouse                                                                                 Marriage Certificate
Party To A Civil Union                                                          Civil Union Certificate

Dependent Child Under Age 21:

           Birth Parent                                                               Birth Certificate

           Legal Guardian                                                         Legal Guardian Documentation

           Adoptive Parent                                                        Adoption Decree or Birth Certificate
           Step Parent                                                              Tax Forms Indicating Child is Claimed As A
Dependent Child Over Age 21:                                            Proof of Full-Time Student Status (Dental Only)
Disabled Child (Over 19)                                                     Completed Medical Verifcation Form

Your Insurance Election Form MUST be returned by June 7 if you wish to make a change during open enrollment.  If the form is not received by the deadline, you will automatically be enrolled in the same plan coverage you elected this year except for the teacher and administrative plan changes as noted above.  If you do not wish to make a change to your coverage, you are not required to return an enrollment form. 

Payroll deductions will be taken in 20 equal payments between 9/6/13 and 5/30/14.  If you are not scheduled to be paid on 9/6, two payments will be taken the following payroll.  The required employee contribution is detailed on the Insurance Election Form.

Please send completed forms directly to me.  Should you have any questions, email Denise Hornyak or call (203) 270-4569.

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