2019 Open Enrollment Materials

Below is a list of Open Enrollment materials 

Active Clergy/Active TAC Fiscal Office Lay Employees

  Document What it's for...
1 2019  Active Employee OE Letter 2019 group health highlights for active clergy and TAC Fiscal Office lay employees
2 2019 OE Instructions

Active clergy and TAC Fiscal Office lay employee open enrollment instructions

3 2019 Overview of Changes

What's changing in 2019 for active clergy and TAC Fiscal Office lay employees

4 2019 Group Health Enrollment Form Submit enrollment form only if making changes in your plan elections or dependent coverages in 2019
5 2019 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.
6 Humana Dental/Vision Plan Summary

Comparison of plans, premiums and enrollment instructions

7 Humana Dental HMO Plan Overview of plan details
8 Humana Dental PPO Plan Overview of plan details
9 Humana Vision 130 Plan Overview of plan details
10 Script Care Pharmacy Benefits Summary Overview of prescription drug plan
11 Script Care Premier Plus Formulary Drug List

Guide to generic, branded generics and brand prescriptions drugs

12 Script Care Premier Plus Formulary Exclusions

Exclusions to the Premier Plus Formulary drug list

13 Script Care ACA Preventive Medications and Immunizations Preventive medications, immunizations, contraceptives, and smoking cessation covered under the Affordable Care Act
14 Script Care Specialty Pharmacy Program and Specialty Drug List

Overview of Specialty Pharmacy Program details

15 Teladoc® Overview of plan details
  Government Required Notices Required legal notices
16 2019 Standard PPO Plan Summary of Benefits and Coverage

Your benefits in health care reform standard format

17 2019 High Deductible PPO Plan Summary of Benefits and Coverage

Your benefits in health care reform standard format

18 HIPAA Privacy Notice

Protection of your personal health information

19 Medicaid and CHIP Premium Assistance Notice

Assistance to help pay for your employer group health plan coverage if you or your children are eligible for Medicaid or CHIP

20 TAC Wellness Program Notice

Wellness program personal health information

21 Women’s Health and Cancer Rights Act Notice

Women’s health and cancer benefit information

 

Under 65 Retirees / Under 65 Spouses of Medicare Primary Participants / Under 65 Surviving Spouses

  Document What it's for...
1 2019 Open Enrollment Letter 2019 group health highlights for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses
2 2019 OE Instructions 2019 enrollment information and instructions for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses
3 2019 Overview of Changes What's changing in 2019 for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses
4 2019 Group Health Enrollment Form Enrollment form for under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses who want to change plan elections
5 2019 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
  All documents numbered 6 – 21 above pertain to under age 65 early retirees, spouses and other dependents of Medicare Primary participants and surviving spouses Additional 2019 OE documents


Benefits Disclaimer         About Your Benefits