What is the deadline to return my forms? What are Flex Credits? How do I complete my Benefit Forms?

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1 What is the deadline to return my forms? What are Flex Credits? How do I complete my Benefit Forms? HR Administration / Benefits Office

2 When are my forms due? You must submit your enrollment forms to the Employee Benefits Department at the District Office by 5:00 PM on or before the last working day of the month prior to your benefits effective date. NOTE: If we do not receive your enrollment forms and all required documentation prior to your benefit start date, you will be automatically enrolled in the employee only Core Plan coverage as of your benefits start date with no other benefit coverage.

3 Where do I submit my forms? At your scheduled New Employee Orientation (NEO) session By US Mail MCCCD Benefits Office 2411 W 14 th Street Tempe, AZ Fax to Feel free to contact us with any questions at or find us online at the address below.

4 Computing Benefit Costs Flex credits are: dollars provided over and above your base salary to help offset the cost of your health insurance. allocated on a monthly basis to spend on options that meet your individual needs. pro-rated for employees on a less than 12 month calendar. If the cost of your selected benefit package exceeds the flex credits, you pay the difference through biweekly payroll deductions. If the cost of your selected benefit package is less than your flex credits, the unused amount is added to your biweekly paycheck as taxable income. Short-term employees have the same options of purchasing additional benefit plans such as Buy-Up medical coverage and dependent health coverage. However, the employee is responsible for any corresponding premiums exceeding the allocated flex credits.

5 Flex Credits The amount of flex credits is based on the employee s employment status and level of medical coverage elected. All numbers are based on a monthly basis. Domestic Partner credits can be found on the benefits website.

6 Benefit Plan Premiums

7 Completing Your Forms The next few slides give an sample of each form you must complete with a description of the purpose of the form and instructions for completion. All forms must be completed and signed before sending them to the District Benefit Office.

8 Benefits Enrollment Form This form is required and documents your benefit elections and dependent enrollments. Employee Info: Complete with your demographic information. Medical/Dental: Mark your medical and dental insurance choice. Dependent Info: List all spouse/child(ren) to be covered on your insurance. Note: If you are going to waive the medical insurance, you must complete the medical waiver form.

9 Benefits Enrollment Form Cont d Supplemental Term Life: You will need to complete an Evidence of Insurability form for elections over $150,000. Dependent Term Life: Evidence of Insurability will be required for any future enrollment/changes. AD&PL (Both Plans): You may elect coverage for just yourself or yourself and your family. Up to $150,000 guaranteed. Any amount over $150,000, can not exceed 10x your salary. Short-Term Disability: Evidence of Insurability is required for amounts over $1,450. Can not exceed 2/3% of your salary. Beneficiary Listing: Your beneficiary designation applies to the $20,000 Basic Life, $15,000 Basic AD&D, as well as Supplemental Life and Supplement AD&PL, if applicable.

10 Benefits Enrollment Form Cont d Sign and date the bottom of the form Your signature authorizes benefit deductions from your paycheck Make sure to sign and date ALL your forms!!

11 Dependent Verification for Health Coverage Form If you are enrolling dependents in any plan, this form is required Submission of documentation is required in addition to signing this form

12 Coordination of Benefits Form This form is used to coordinate health insurance benefits if you are enrolling yourself or your dependents in MCCCD s health insurance and you or your dependents are also enrolled in another group health insurance program. It is required of all employees who have elected the MCCCD medical insurance. If you are waiving health insurance this form is not required.

13 Medical Waiver Form MCCCD s health insurance policy requires all benefits eligible employees must be on a group medical insurance plan. Employees who are on another group medical insurance plan may waive MCCCD s medical insurance. You must document your enrollment in another group medical insurance plan by completing the Medical Waiver form.

14 Life Insurance Evidence of Insurability (EofI) Form This form must be completed if you are requesting Supplemental Life insurance in an amount greater than $150,000. Evidence of Insurability, also called Proof of Good Health, is an application process in which you provide information on the condition of your health in order to be approved for coverage. As part of the process, you may be asked to take some medical tests at your expense.

15 Short-Term Disability Evident of Insurability (EofI) Form This form must be completed if you are requesting Short Term Disability insurance in an amount greater than $1450. Evidence of Insurability, also called Proof of Good Health, is an application process in which you provide information on the condition of your health in order to be approved for coverage. As part of the process, you may be asked to take some medical tests at your expense.

16 Tuition Waiver Form This form is used to list all dependents who are eligible for the MCCCD Tuition waiver. Those waiving medical coverage could still have dependents that qualify for the benefit. If you are an OYO or OSO employee, your dependents are not eligible.

17 Flexible Spending Account (FSA) During the plan year, you may incur eligible expenses in health care and/or dependent care. With an FSA you submit a claim for reimbursement and you are paid back out of your pre-tax amounts. The amount you designate for a dependent care FSA is taken out of your paycheck each pay period. The amount you contribute is the Annual Election amount divided by the number of pay periods Dependent Care: Available for all Board Approved employees Health Care: Not eligible for New Hires Please remember these accounts are Use It or Lose It. For more information please visit our website.

18 What Are My Out of Pocket Costs? Use the Out of Pocket Cost Calc sheet to fill in your flex credits and costs. The sheet will compute your balance to determine if you will have any out of pocket costs The balance shown is a monthly rate. For less than 12-month employees your per pay period rate is pro-rated.