Employee completes a new
STD. C and/or STD. R. If an enrollment form was actually completed indicate at the top "Cancelling Open Enrollment Form". If employee is completing a STD. C to cancel his/her automatic reenrollment, indicate at the top "Cancelling Automatic Reenrollment".
Items , and , must be completed and the employee must sign and date in Item
On the STD. C, Sections A, B and C must also be completed to indicate what Cash Option amount is to be cancelled by zeroing out the cancelled portion.
The Personnel Office must complete their appropriate sections and forward to SCO.
Changes - STD. C and/or STD. R
Employee completes a new STD. C and/or STD. R. Indicate at the top "Changing Open Enrollment Form".
All sections on the form must be completed just as if the election had been made during the open enrollment period. The information on the form should reflect the changes you are requesting. For example, if you are deleting the db to data dental cash, but maintaining the medical cash, the amount of $ should be listed on A as well as the total on C of the STD. C. For a change in a reimbursement account, simply list the correct deduction amount(s) on lines A and/or B on the STD. R.
The Personnel Office will complete their appropriate sections and forward to SCO.
If the HBD- (Health) and STD. (Dental) forms were completed cancelling coverage and the employee now wants to maintain coverage, new forms reenrolling the employee must be completed and forwarded along with the STD. C.
Example Situations
Following are some examples of different scenarios of FlexElect options employees may choose. Please keep in mind these are examples to help illustrate what form(s) should be completed. With every different situation and dates involved, the form(s) will be completed differently.
Each example begins with an explanation of the employee's current status, his/her desired FlexElect elections, and the actions required by the employee, his/her spouse or domestic partner, and the Personnel Office.
In all examples, the "employee" is the State employee and is the principal figure in the scenario. The "employee's spouse or domestic partner" in some examples is a State employee or may be employed by private industry.
The information/examples in this manual does not reflect every possible type of enrollment/change within FlexElect but hopefully provide a broad range of enrollment and change situations.
Example - Open Enrollment/Cash Option (New Enrollment)
SITUATION: Open Enrollment, Cash Option for Medical and Dental - New Enrollment, Spouse or Domestic Partner Also a State Employee
Employee: Jack A. Gordon
Spouse/Domestic Partner: Jill A. Gordon (also a State employee)
CURRENT STATUS
Employee is currently enrolled in his own State-sponsored medical and dental insurance plans. Employee's spouse or domestic partner, who is also a State employee, is currently enrolled in her own State-sponsored medical and dental insurance plans. Spouse or domestic partner is not currently covering any dependents.
Items , and , must be completed and the employee must sign and date in Item
On the STD. C, Sections A, B and C must also be completed to indicate what Cash Option amount is to be cancelled by zeroing out the cancelled portion.
The Personnel Office must complete their appropriate sections and forward to SCO.
Changes - STD. C and/or STD. R
Employee completes a new STD. C and/or STD. R. Indicate at the top "Changing Open Enrollment Form".
All sections on the form must be completed just as if the election had been made during the open enrollment period. The information on the form should reflect the changes you are requesting. For example, if you are deleting the db to data dental cash, but maintaining the medical cash, the amount of $ should be listed on A as well as the total on C of the STD. C. For a change in a reimbursement account, simply list the correct deduction amount(s) on lines A and/or B on the STD. R.
The Personnel Office will complete their appropriate sections and forward to SCO.
If the HBD- (Health) and STD. (Dental) forms were completed cancelling coverage and the employee now wants to maintain coverage, new forms reenrolling the employee must be completed and forwarded along with the STD. C.Example Situations
Following are some examples of different scenarios of FlexElect options employees may choose. Please keep in mind these are examples to help illustrate what form(s) should be completed. With every different situation and dates involved, the form(s) will be completed differently.
Each example begins with an explanation of the employee's current status, his/her desired FlexElect elections, and the actions required by the employee, his/her spouse or domestic partner, and the Personnel Office.
In all examples, the "employee" is the State employee and is the principal figure in the scenario. The "employee's spouse or domestic partner" in some examples is a State employee or may be employed by private industry.
The information/examples in this manual does not reflect every possible type of enrollment/change within FlexElect but hopefully provide a broad range of enrollment and change situations.
Example - Open Enrollment/Cash Option (New Enrollment)
SITUATION: Open Enrollment, Cash Option for Medical and Dental - New Enrollment, Spouse or Domestic Partner Also a State Employee
Employee: Jack A. Gordon
Spouse/Domestic Partner: Jill A. Gordon (also a State employee)
CURRENT STATUS
Employee is currently enrolled in his own State-sponsored medical and dental insurance plans. Employee's spouse or domestic partner, who is also a State employee, is currently enrolled in her own State-sponsored medical and dental insurance plans. Spouse or domestic partner is not currently covering any dependents.
