Open Enrollment 2017
November 01, 2016 - November 11, 2016
Open Enrollment Change Form for New Enrollments or Plan Changes
Click here to view the Open Enrollment Guide. This guide includes everything you need to know for Open Enrollment. It includes
all benefit summaries, rates, information on adding dependents and more.
This year, only new enrollments or plan changes must be submitted. If you are currently
enrolled in the Medical PPO70 plan, you must enroll in a new plan for 2016 using the
online Open Enrollment Change Form. If you would like to enroll in a Flexible Spending
Account (Medical or Depedent Care) or Health Savings Account for 2016, you must submit
an enrollment form to Human Resources by Friday November 13th.
*Persons who do not have access to the internet or who have trouble using the online
form should contact the HR Office at (972) 721-5382. Paper enrollment forms and materials
are available upon request.
Enrollment form will be available beginning Monday, November 3.
Adding Dependents Employees must include dependent documentation when adding eligible family members.
Dependent Certification Form