NEWTOWN PUBLIC SCHOOLS
3 PRIMROSE STREET
NEWTOWN, CT 06470
DATE: May 11, 2015
TO: Eligible Employee
FROM: Denise Hornyak, Insurance Coordinator
SUBJECT: Medical/Dental Insurance – Open Enrollment
Response Required by June 5
Open enrollment will occur between May 11 and June 5 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 2016 for plan coverage during 2016-17. Changes outside the open enrollment period are only permitted if a qualified change in life status has occurred.
Along with your Insurance Election Form you must complete an Anthem application for health insurance and a TR Paul application for dental insurance 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
Dependent Child Over Age 21: Proof of Full-Time Student Status (Dental Only)
Disabled Child (Over 26) Completed Medical Verification Form
All forms MUST be returned by June 5 if you wish to make a change during open enrollment. If the forms are not received by the deadline, you will automatically be enrolled in the same plan coverage you elected this year. 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 9/4/15 and 5/27/16. If you are not scheduled to be paid on 9/4, two payments will be taken the following payroll. The required employee contribution is detailed on the Insurance Election Form.
Information for all eligible employees and necessary forms can be obtained as of Monday, May 11th on the Newtown District Website, www.newtown.k12.ct.us, and can be accessed by clicking on the Department/Business Office. Refer to the appropriate employee box for information and forms. In addition, please review the information regarding Anthem Travel assistance coverage and Anthem Life Resource Advisor, which are two additional benefits provided by Anthem for all employees eligible for medical coverage.
Please send completed forms directly to me. Should you have any questions, email Denise Hornyak or call (203) 270-4569.