2010 Benefits Enrollment

	2010 Enrollment Information
Publications
	Overall 2009 Benefits Guide for Active State Employees 2009 Benefits Guide for Retirees 2009 Retiree Benefits Package 2009 Enrollment Readiness Checklist 2009-2010 Retiree Rate Chart Forms and Publications HMO Certificates of Coverage Avmed Health Investor Avmed Standard Capital Health Plan Florida Health Care Plan (FHCP) United Healthcare Standard United Healthcare Health Investor Vista Healthplan Group Life Life and Disability Insurance Group Life Insurance Beneficiary Designation Minnesota Life Brochure SMS/SES Disability Insurance Brochure Life Insurance Plans FSAs and HSAs FSA/HSA Enrollment Plan HSA Application and Disclosure Package Tax-Favored Accounts (FSA/HSA) Additional Supplemental Coverage AFLAC Brochure Alta Brochure Colonial Life Brochure Philadelphia American Life Brochure	Medical PPO Plan Benefit Document - 2008 Changes 2009 BCBSF PPO Plan Benefit Document PPO 2009 Open Enrollment Brochure HIPAA Privacy Notice Medicare Part D Notice of Creditable Coverage for State Employees Prescription Drug RxBenefits at a Glance (Standard PPO) RxBenefits at a Glance (Health Investor PPO) Guide on Generics Guide on Weather Emergencies Guide to Improve Health Guide to Mail Service Guide When Seeing a Doctor Dental and Vision Ameritas Assurant CIGNA Comp Benefits PPO and Indemnity (Plans) Comp Benefits Prepaid Dental Plans UnitedHealthcare Dental Plans Dental Enrollment/Change Form Humana Vision
Enrollment and Claiming Benefits
	To Enroll Health Health Insurance Enrollment/Change Form Pre-Tax Premium Waiver Form Qualified Status Change Form (required to make benefit changes during the year) Surviving Spouse Enrollment/Change Form Spouse Program Enrollment/Change Form Retiree Health Insurance Election Form FSAs and HSAs FSA/HSA Enrollment Form HSA Application and Disclosure Package Group Life Group Life Enrollment Form Group Life Insurance Beneficiary Designation Group Life Short-Form Questionnaire (for Optional Life coverage) Qualified Status Change Form (required to make benefit changes during the year) Supplemental Benefits Accident Disability Enrollment/Change Form Cancer/Intensive Care Enrollment/Change Form Dental Enrollment/Change Form Vision Enrollment/Change Form Supplemental Hospital Insurance Enrollment/Change Form Supplemental Plans If you are leaving the state's employment FSA-MRA Termination of Employment Form	To Claim Benefits Health PPO Plan Non-Network Claims Form PPO Prescription Non-Network Claim Form PPO Prescription Mail Order Form Authorization to Use and/or Disclose Personal Health Information Form FSAs and HSAs FSA Reimbursement Claim Form FSA-MRA Letter of Medical Need Life and Disability Insurance SMS/SES Disability Insurance Claim Form Cost Estimators Health Plan Cost Estimator Dental Plan Cost Estimator Medical Reimbursement Account Estimator Limited Purpose Medical Reimbursement Account Estimator Dependent Care Reimbursement Account Estimator