2012 Calendar Year Open Enrollment

October 24th, 2011 through November 23rd, 2011

Open Enrollment is an opportunity to make changes to your current health, dental, vision, and /or dependent care flexible spending, supplemental life insurance and short term disability benefits. New for 2012, non-bargaining faculty and staff will have the option to select health care, dental and vision individually.

2012 Open Enrollment Video Presentation

2012 Calendar Year Open Enrollment Announcement, October 24, 2011
2012 Calendar Year Open Enrollment Announcement, October 31, 2011
2012 Open Enrollment PowerPoint Presentation
2012 Open Enrollment Meeting Schedule
2012 Open Enrollment Packet (non-bargaining unit faculty and staff)
2012 Open Enrollment Packet (bargaining unit faculty)

2012 Non-Bargaining Faculty and Staff Rate Sheet
2012 Non-Bargaining Faculty and Staff Rate Sheet (HB1 Rate Sheet 26-28 year old)
2012 Part-Time (51%-74% FTE) Employee Contribution
2012 Bargaining Unit Faculty Rate Sheet
2012 Bargaining Unit Faculty (HB1 Rate Sheet 26-28 year old)

Forms and Highlight Sheets:

2012 Health Insurance Enrollment/Change Form
2012 Health Insurance Enrollment/Change Form *FOR BARGAINING UNIT FACULTY ONLY.
How to complete the Health Insurance Enrollment/Change Form?
Dependent Definitions & Document Requirements

2012 Adult Child Eligibility Grid
19-26 Adult Child Certification Form
26-28 Adult Child Certification Form
26-28 Adult Child Affidavit Form
26-28 Adult Child Health Enrollment Form

2012 Flexible Spending Agreement Form
2012 Flexible Spending Account Eligible Expenses
2012 Flexible Spending Highlight Sheets

2012 Health Savings Reduction Form * For CURRENT and NEW participants.
2012 Health Savings Fifth Third Bank Form *For NEW participants ONLY. If enrolling in a new 5th3rd HSA, please set up account after December 15th for 2012 plan year.
2012 Health Savings Account Certification of Eligibility *For NEW participants ONLY.
2012 Health Savings Account Highlight Sheet
2012 Health Savings Account Detailed Summary

2012 High Deductible Health Plan Summary
2012 PPO Summary
2012 HMO Summary

2012 Prescription Drug Benefits Summary

2012 Dental Summary
2012 Passport Dental
2012 Mobile Dentist Search

2012 Vision Summary
2012 Vision-Coordination of Benefits
2012 Vision-Contact Lens Fitting & Evaluation

Voluntary Short Term Disability and Employer-Paid Long Term Disability
Wright State Short-Term Disability Insurance
2012 Short Term Disability Highlight Sheet
2012 Short Term Disability Enrollment Form * Both enrollment form and evidence of insurability forms are required
2012 Unum Evidence of Insurability Form

Employer Provided and Voluntary Life Insurance

Life Insurance Summary

Dependent Life Insurance Coverage Election Form

Group Term Life Highlight Sheet
Group Term Life Enrollment Form

Group Universal Life Highlight Sheet
Group Universal Life Enrollment Form

Electing a Beneficiary
Updating Beneficiary - Video http://portal.sliderocket.com/LifeBenefits/WSUbeneficiary
Beneficiary Designation Form

Important Dates:

October 24th through November 23rd, 2011
Beginning of Open Enrollment for the 2012 plan year. Submit your benefit elections manually by printing forms from the HR website,
complete and return to the Department of Human Resources.

November 23rd, 2011
Deadline for all forms to be completed and returned to the Department of Human Resources.

October 31st through November 18th, 2011
Open Enrollment meetings scheduled for faculty and staff

January 1st, 2012
The date that benefit plan elections made during this Open Enrollment Period become effective.

Communications:
Important Medicare Part D Notice mailed 10.14.2011

Target Communication: Current Dependent Life Insurance Participants
Target Communication: Current Dependent Care Flexible Spending Account Participants
Target Communication: Current Healthcare Flexible Spending Account Participants
Target Communication: Current Group Universal Life Insurance Participants
Target Communication: Current Health Savings Account Participants
Target Communication: Current Term Life Insurance Participants