TELLER COUNTY HUMAN RESOURCES DEPARTMENT
Sandi Stratton,
Personnel/Benefits Specialist
Lindsey Chapman, HR
Specialist
P.O. Box 959/112 North "A" Street
Cripple Creek, Colorado 80813
689-2988 * Fax 686-7900
CHANGES TO HEALTH, DENTAL AND VISION INSURANCE BENEFITS – 2012
During the year you may find it
necessary to make changes to your insurance coverage. If you have had a
Legal Qualified Event, you have thirty days from that qualifying
event to make a change to your coverage. Some examples of a Legal Qualified
Event are:
· Your spouse has coverage through his/her employer, and the employer has dropped insurance coverage or your spouse has been laid off, terminated or quit working for that employer.
· Your spouse’s employer has changed their benefit coverage, or changed the employee contribution amount the employees have to pay toward their coverage.
· Getting Married or Divorced (becoming separated does not count as a Legal Qualified Event, unless it is a Legal Separation).
· Having a Baby or adopting a child.
· If you have your spouse on your insurance and your spouse gets a new job and wants to use the new employer’s benefits.
If you have questions about the above or think you may have a Legal Qualifying Event that is not listed here, please contact Sandi Stratton in Human Resources at (719) 686-7914.
Some of the Forms you will need to make changes to your coverage due to a Legal Qualified Event are listed below. Click on the link to access and print the form.
If you are making changes to
your Health Insurance you will need:
If you have the High Deductible Health Plan:
· Humana Enrollment Application/Instructions (link)
·
2012 HDHP Election/H.S.A.
Contribution Form
(link)
If you have the PPO Plan:
o Humana Enrollment Applications/Instructions (link)
o 2012 PPO Election Form (link)
If you are making changes to your Delta Dental Insurance you will need:
· Delta Dental Application Form (link)
● 2012 Dental Form (link)
If you are making changes to your Vision Insurance coverage you will need:
· VSP Enrollment Form (link)
If you have gone through a Divorce or a Legal Separation, or you are adding a Common-Law- Spouse to your Insurance Coverage, or Step-Children due to a Common-Law-Marriage, we will need you to complete or provide additional paperwork. Please call the HR Department, per the instructions below, and we will send you the additional forms you may need.
The HR Department will process your change as quickly as we are able to. Because there may be additional paperwork needed, you will need to let HR know immediately if you are anticipating a Legal Qualified Event so we can make sure we get everything submitted to Humana, Delta Dental or VSP in time so your request is not denied by them.
Instructions:
· Please download the forms you will need and fill each form out completely. Please look for the signature line on each form, as many times we receive these forms filled out, but no signature on the signature line. No changes can be processed unless you sign your forms.
· Send your forms through relay mail to Sandi Stratton in Human Resources.
·
Call Human Resources at (719)
689-2988 to let us know your paperwork is being sent through relay mail and let
us know what change to your benefits you want to make.
· Remember, we only have thirty days from the legal qualifying event date to get any changes into our insurance carriers!