To Make Changes
If you are interested in enrolling into a new plan or adding/removing dependents, please complete the forms for the providers you choose (available in our Human Resources Office or in the links below) and the 2021 Open Enrollment Form(PDF) and return them to Human Resources by Friday, October 16, 2020 before 4:00PM.
To Keep Existing Coverage
If you are satisfied with your health coverage and do not want to make any changes, current employees must still complete the 2021 Open Enrollment Form (PDF) as well as all corresponding plan enrollment forms. For your convenience, here is a summary of the plan rates for 2021. (PDF).
2021 Open Enrollment FAQs and Information
Open enrollment is your opportunity to review and make changes to your medical, dental, and vision plans. During Open Enrollment you can add, delete, or change plans, or add/remove dependents from your coverage. To help navigate through Open Enrollment, we have included several frequently asked questions for your review.
The Shops offer Kaiser HMO, Anthem HMO & HMO Select and Anthem PPO.
Your plan options are:
Anthem HMO Select
Anthem HMO Traditional
The Shops will continue to offer the same dental plan benefits as we did last year. Our plan of choice is Delta Dental.
Delta Dental HMO
Delta Dental HMO (PDF)
Delta Dental PPO
- Delta Dental PPO (PDF)
Delta Dental Resources
The Shops will continue to offer the same vision plan benefits as we did last year. Our plan of choice is VSP.
Hartford Life and AD&D Insurance
The Shops offers employer-sponsored life and disability insurance to full time employees. Below are plan summaries and services available for you.
- Hartford Basic Life and AD&D (PDF)
- Hartford Short Term Disability (PDF)
- Hartford Additional Services (PDF)
- Hartford Ability Assist (PDF)
Voluntary Life and Accident Death & Dismemberment Plan
This year we will continue to offer a Voluntary Life and Accidental Death and Dismemberment Plan (AD&D). This plan will allow you to purchase additional life and/or AD&D coverage for you and your family. These voluntary plans are offered through The Hartford and provide peace of mind that your family will be provided for should something unexpected happen.
Hartford Voluntary Plan (PDF)
Hartford Beneficiary Form
To update the beneficiary designation for your plan please complete the following form and return to Human Resources at any time:
Flexible Spending Account Option
The Flexible Spending Account is a voluntary plan where you elect to have automatic deductions taken from your check and put into a Flex Plan so that you do not pay taxes on that amount. The money that you elect to deduct can either be used to reimburse you for medical expenses and/or for childcare expenses that you incur during the plan year, depending on the deduction amounts for each plan in which you enroll.
The maximum annual contribution limit for Medical Flexible Spending Accounts is $2,700 and for Dependent Care is $5,000.
Benefits Waiver Program
The Forty-Niner Shops offers a Benefits Waiver Program to help manage your benefits coverage. If you have medical, dental, and vision coverage outside of the Shops, the Benefits Waiver Program pays you cash in lieu of medical coverage. You must provide proof of coverage to participate. To learn more about this program, please see the Benefits Waiver Programs summary below.