Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.
Have you recently had a baby? Gotten married? Divorced? Moved? Throughout the year you may experience life events that allow you to change your benefits outside of the annual open enrollment period. The life events guide explains deadlines, required documentation, and which events allow you to make changes.
Program Option
Local Annuitant Health Program (LAHP)
Local Deductible Health Plan (PO14) & Supplemental Benefits
Local Deductible Health Plan with Uniform Dental (PO4) & Supplemental Benefits
Local Health Plan (PO16) & Supplemental Benefits
Local Health Plan with Uniform Dental (PO6) & Supplemental Benefits
Local High Deductible Health Plan (PO17) & Supplemental Benefits
Local High Deductible Health Plan with Uniform Dental (PO7) & Supplemental Benefits
Local Traditional Health Plan (PO12) & Supplemental Benefits
Local Traditional Health Plan with Uniform Dental (PO2) & Supplemental Benefits
State Employee and Retiree Health Plan & Supplemental Benefits
Benefits include: Health, Wellness, Dental, Vision, Accidental Death and Dismemberment (AD&D), Long-Term Care and Pre-Tax Savings Accounts. Sign up and learn more about your health benefits.
Plan Year
2024
Program Option
State Employee and Retiree Health Plan & Supplemental Benefits
