Open Enrollment including Health Insurance Buy-out (IS CLOSED for CY2024)
Make sure you are using CURRENT forms. They have a revision date of 10/11/2022 or newer on them.
Election of these benefits is only available at the time of hire or during Open Enrollment unless you have a HIPAA qualifying event.
What is a Section 125 Cafeteria Plan - A Cafeteria Plan is a reimbursement plan governed by IRS Section 125 which allows employees to contribute a certain amount of their gross income to a designated account or accounts before taxes are calculated. These accounts can be for insurance premiums and medical or dependent care expenses not covered by insurance, from which employees can be reimbursed throughout the plan year or claim period as they incur the expenses. A Cafeteria Plan allows the employer to reduce employees’ gross income, thereby reducing the amount the company pays in Federal Insurance Contributions Act (FICA or Social Security), Federal Unemployment Tax Act (FUTA), Workers’ Compensation, and some State taxes.
Our cafeteria plan includes these options: (click here to review the plan document)
You must enroll during every open enrollment. No late submissions will be accepted if you miss the deadline.
Health Flexible Spending Account (FSA)
Dependent Care Assistance (DCAP)
Health Savings Account (HSA) Silver CDHP Plan ONLY Link to DataPath's HSA information
Health Insurance Buy-out (Cash in Lieu)
Waiver of Premium Conversion (electing this option allows you to pay taxes on your insurance premiums instead of a pre-tax deduction)
Open enrollment is the time to add or delete Spouse/Dependents/Domestic Partners, change your plan election or cancel your coverage. IF YOU ARE NOT MAKING CHANGES TO YOUR COVERAGE OR WHO IS COVERED BY THE PLAN YOU DO NOT NEED TO COMPLETE ANY MEDICAL OR DENTAL FORMS.
- Health Insurance Enrollment/Change form (also will need to fill out any additional sub-files below that go with change)
- Statement of Domestic Partnership
- HRA Enrollment form (need this form for changes to Platinum, Gold, or Gold CDHP plans)
- HSA Enrollment form (need this form for changes to Silver CDHP plan only)
- Dental Insurance Enrollment/Change form
- Health Flex Spending Account (FSA), and Dependent Care Assistance Program (DCAP) Booklet
- includes claim forms, worksheets and myRSC instructions