2020-2021 Health Benefits Open Enrollment
Please complete the health benefits open enrollment form online to complete your health benefit selections for the 2020-2021 plan year. All submissions are considered final, and irreversible. The last day for submission is Friday, June 5, 2020 at 4:30 pm
Important Dates to Remember:
May 11th - Open Enrollment Presentation Option 1 3:00 pm to 4:00 pm via Google Meets
May 19th - Open Enrollment Presentation Option 2 9:00 am to 10:00 am via Google Meets
May 21st - Open Enrollment Presentation Option 3 1:00 pm to 2:00 pm via Google Meets
If you miss the open enrollment window to make final selections, the plan will automatically roll to the same plan or comparable plan you are currently enrolled on with the same dependent/spouse information on file with the District. If you miss the open enrollment window to make final selections, you understand as an employee of the District that you have waived your right to make changes, and therefore you will be unable to change your selections until the 2021 Open Enrollment window for the 2021-2022 plan year. As an additional caution, failure to review and complete the online benefit selections for open enrollment with your final submission does not hold the District liable for plan premium increases if the plan selected is higher than your 2019-2020 plan selection.
Please review all of the plan documents to ensure that you have selected the plan that best meets your needs.
Employee First Name
Employee Last Name
Employee Phone Number
Are you planning to enroll in a Health Benefit plan for the 2020 Open Enrollment?
No - I am declining coverage (less than full-time)
No - I am declining coverage (WABE option - full time employee)
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This form was created inside of Lucia Mar Unified School District.