Benefits Enrollment Instructions
Generally, there are three times when benefit-eligible employees can enroll in or may be able to change benefits: 1) as a newly hired or benefit eligible employee, 2) after experiencing a qualifying status change event, or 3) during open enrollment. Follow the procedures below to complete your enrollment.
New Employee or New Benefit-Eligible Employee
All new benefit-eligible employees must complete the Benefits Election/Change Summary - Form 3075 and applicable insurance enrollment forms. All forms must be received by the Office of Human Resources within 30 days of coverage effective date. Failure to submit elections within the 30-day deadline will result in no insurance coverage for the entire plan year.
Qualifying Event/Special Enrollment Period
If you have a qualifying "status change" event during the year, you may be allowed to make changes to your benefits mid-year. Link to life events - special enrollment period for additional information regarding qualifying status change events. All benefit enrollment/change forms must be received by the Office of Human Resources within 30 days of the event.
Benefit Open Enrollment
During the benefit open enrollment period, current eligible employees may switch, add, adjust or cancel insurance and/or add or remove spouse or dependent(s) from insurances. Here's how you get started:
Review Important Dates | The next open enrollment period is October 22, 2012 through November 2, 2012. Your changes must be submitted to the Office of Human Resources by November 2, 2012. The effective date of change to your benefits is January 1, 2013. |
Review Your Benefits Open Enrollment Material | Review the 2013 Benefit Newsletter and Benefit Guide to learn what's happening for 2013. Login to Bannerweb at www.ltu.edu/bannerweb to review your current benefits and beneficiary/dependent information. |
All Employees Must Complete
| All employees must complete the 2013 Benefits Election/Change Summary Form #3075. All employees must complete The Hartford (Life Insurance) Enrollment Form. All employees must complete the 2013 Flexible Spending Account Election Form to enroll or re-enroll in the FSA Health Care and/or Dependent Care plan. NOTE: The AHL EPO, AHL PPO and BCN HMO medical plans will terminate on 12/31/2012. ALL EMPLOYEES must complete the BCBSM/BCN Enrollment/Change of Status form to enroll in either BCN Healthy Blue Living HMO or BCBSM Simply Blue PPO medical plan or complete the Waiver of Coverage Certification of Other Insurance Form. In addition, you will need to make elections:
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Submit your 2013 Benefit Elections - Paper or Online | You have two ways to submit changes to your benefit elections - paper or online. NOTE: If you are making ANY changes to your current benefits, you must download and complete the applicable insurance enrollment/change form(s). |
Paper Enrollment | Download, complete and return the following benefit enrollment/change forms:
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Bannerweb Online Enrollment | You can complete your benefits open enrollment changes by logging on to Bannerweb at http://www.ltu.edu/bannerweb. Step 1 Click Login to Secure Area Step 2 Click Employee Services Step 3 Click Benefits and Deductions Step 4 Click Start Open Enrollment and follow instructions Step 5 Click Complete to update your change(s) Step 6 Click Calculate Cost Step 7 Print, sign and submit the Calculate Cost page to Human Resources NOTE: The Calculate Cost page will serve as your web 2013 Benefits Election/Change Summary Form. Step 8 Download, complete and return the following benefits enrollment/change forms:
Step 9 Submit all signed forms to Human Resources by November 2, 2012. |
If you want to enroll or re-enroll in the FSA Health Care and/or Dependent Care plan for 2013, you must submit the Flexible Spending Account Election - Form #3013 annually. | |
Waiver of Coverage Certification of Other Insurance Election
| If you want to waive any or all health coverage for 2013, you must submit the Waiver of Insurance Election - Form #3012. If you are currently waiving insurance coverage and do not elect coverage for 2013, your current "waive insurance" election will automatically continue for 2013.
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Questions? Email benefits@ltu.edu.
Limitations
Lawrence Tech in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.
Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Office of Human Resources reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern. Lawrence Tech in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents.