HBR Annual Enrollment
Annual Enrollment PowerPoint Presentation
Annual Enrollment Presentation without Narrator (5 MB)Annual Enrollment Kits and Forms 2010
If you use paper enrollment, please be sure to keep a copy of the enrollment and attestation forms for your records.
Annual Enrollment Kit for paper agencies and the Department of Corrections
This kit contains all the enrollment material for employees of agencies that enroll by paper, including the Department of Corrections.
Annual Enrollment Kit for BEACON
This kit contains all the enrollment materials for the employees of agencies and entities using the BEACON system.
Annual Enrollment Kit for HR InTouch/eBenefitsNow
This kit contains all the enrollment materials for the employees of agencies that use HR InTouch/eBenefitsNow.
Annual Enrollment Kit for COBRA -- direct bill members
This kit contains all the enrollment materials for COBRA and direct bill members.
Annual Enrollment Kit for Medicare primary retirees
This kit contains all the enrollment materials for retirees that have Medicare as their primary coverage.
Annual Enrollment Kit for State Health Plan primary retirees
This kit contains all the enrollment materials for retirees that have the State Health Plan as their primary coverage.
Forms
Attestation Form/Annual Enrollment Form
The Attestation Form is a legally binding document that subscribers who have the State Health Plan as their primary health coverage must complete to enroll in the Standard 80/20 plan. Use the Annual Enrollment Form to select the plan you are eligible to enroll in, to add or remove dependents, and/or update your personal information.
Annual Enrollment Form for Medicare Primary Members
If you have Medicare as your primary health coverage, use this Annual Enrollment Form to select the plan you are eligible to enroll in, to add or remove dependents, and/or update your personal information. Or, complete this form if you want to remain in the 70/30 Basic plan and you are only adding/or removing dependents and/or updating your personal information.
Physician Certification Form
All members who are applying for an exemption to enroll in the 80/20 Standard plan due to participation in a tobacco cessation program must complete the Physician Certification Form.
