Medical - Family Coverage

Please consult the benefits summary you received from human resources for plan costs and deductible amounts.

When electing medical coverage, you MUST also complete an Affidavit for the Tobacco-Free Incentive Plan, in order to qualify for the reduced premiums. If this form is not returned, you will be enrolled at the base plan premium with Loss of Tobacco-Free Incentive.

When electing medical coverage, you MUST also complete a Spousal Surcharge Form to determine whether you are subject to the spousal surcharge added to your premiums. If this form is not returned, the spousal surcharge will be added automatically.

When enrolling in our PPO Medical plan, you have the option to elect a Flexible Spending Account, for pre-tax deductions to cover out of pocket expenses. (FOR PPO PLAN ONLY)

When enrolling in our HDHP Medical plan, you have the option to elect a Health Savings Account, for pre-tax deductions to cover out of pocket expenses. (FOR HDHP PLAN ONLY)