NEWTOWN PUBLIC SCHOOLS
3 PRIMROSE STREET
NEWTOWN, CT 06470
DATE: May 11, 2017
TO: Eligible Employee
FROM: Denise Hornyak, Insurance Coordinator
SUBJECT: Medical/Dental Insurance – Open Enrollment
Response Required by June 9
Open enrollment will occur between May 11th and June 9th this year for medical, dental, and voluntary vision 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 this period only. The next open enrollment period will not occur until May/June 2018 for plan coverage during 2018-19. Changes outside the open enrollment period are only permitted if a qualified change in life status has occurred.
As of July 1, 2017, all teachers and administrators currently enrolled in the Anthem PPO 30/40 or PPO Comp Mix medical coverage will be automatically enrolled in the HSA.
- If you do not want to be automatically transferred or do not want to re-enroll in the HSA plan, you must complete an Insurance Election Form waiving medical coverage for the 2017-2018 plan year.
- Employees or their spouses that are currently contributing to a Flex Medical Account and/or an employee who has Medicare are not eligible to enroll in a HSA. Please refer to additional information provided on the website regarding IRS regulations for HSA, Medicare and Flex Medical Accounts and other insurance coverage with spouse.
- If you choose to enroll in the HSA for the first time, you must complete an Insurance Election Form, and if desired a HSA Payroll Deduction Form.
Along with your Insurance Election Form you must complete an Anthem Enrollment Form for health insurance, a TR Paul Enrollment Form for dental insurance, and an Anthem Voluntary Vision Enrollment Form if you are enrolling for the first time or adding a dependent. In addition 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 9th if you wish to make a change during open enrollment. If the form(s) 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 9/1/17 and 5/25/18. If you are not scheduled to be paid on 9/1, two payments will be taken the following payroll. ParaEducator payroll deductions will be taken out in 19 equal payments between 9/15/17 and 6/08/18. The required employee contribution is detailed on the appropriate employee Insurance Election Form.
Information for all eligible employees and necessary forms to enroll in the medical, vision and/or dental insurance coverage can be obtained as of Thursday, May 11th, on the Newtown District Website, www.newtown.k12.ct.us, and can be accessed by clicking on the Department/Business Office, Employee Insurance Information and Forms 2017-2018 and referring to the appropriate employee box for the 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, please email me at email@example.com or call (203) 270-4569.
The IRS Health Saving Account (HSA) limits for 2017 (in PDF)