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P A G E 9
Enrollment Worksheet Tips
Review all of the Open Enrollment materials provided. You may view the presentation any time
under Company Folders/Company/Employee Information/Benefits/
2016 2017 Open Enrollment
Presentation or request a copy from Human Resources.
Complete the Employee Election Form.
Please Note: If you are waiving medical coverage, you must provide proof of coverage elsewhere.
The Standard Enrollment Form
only
if you are enrolling or waiving voluntary life plan for the first time.
If enrolling, Medical History form is required.
During this time of year, it is also good to revisit your beneficiaries you’ve designated on your Life
Insurance and 401k/Profit Sharing Plan. If you’d like to make changes, please reach out to Human
Resources to request a Beneficiary Form.
Return all forms to Human Resources no later than Thursday, November 17th.
Other Important Dates to Remember:
New benefit plan deductions begin with the pay of 12/23/16.
New FSA and HSA deductions begin with the pay of 12/23/16.