Open  Enrollment  Online  System  User  Agreement  

Employee  Enrollment  Access  Authorization  (May  1  to  June  14)  

 

Participating Employer:

Member #

1. As the employer, we elect to allow our employees to complete their annual Open Enrollment Elections electronically effective May 1, 2015.

2. As a participating employer we can choose to enroll those who do not wish to use the online system or forward the enrollment forms to the Center for Nonprofit Advancement’s Benefits Trust by mail or fax for processing.

3. As the employer, we understand that we are responsible for reviewing all Open Enrollment transactions between May 1 and June 14 for accuracy.

4. We agree that the information provided as part of the enrollment process may be stored by the Center for Nonprofit Advancement’s Benefits Trust for reference purposes and transmission to insurance companies. We may provide aggregate statistical information about enrollments to our health plan providers and may use the information to inform you about other publications, products, and services of the Center for Nonprofit Advancement.

5. This Agreement may be terminated by either party for any reason at any time.

The undersigned participating employer requests approval as a participant under the Center for Nonprofit Advancement’s Benefits Trust, and hereby accepts and agrees to be bound by the terms of the “MEWA Plan Document”. The undersigned hereby accepts and agrees to be bound by the participation requirements of the Trust, which are set forth on this form, Summary Plan Description (SPD) and all Multiple Employer Welfare Arrangement (MEWA) documents. Signing this form does not guarantee coverage/insurability of employees using the online enrollment system. Acknowledgement:

Signature: Print Name Print Title Date

Employee Open Enrollment System

Employee Open Enrollment System

The Employee Enrollment System user will need a computer with a web browser and an active connection to the internet.

Center will not provide this to any employee).

Quick URL link to the system: http://www.nonprofitadvancement.org/OpenEnrollment (Click the apple)

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Employee Open Enrollment System

You must enter:

Member ID 2. Social security number 3. Date of birth (Your employer must provide their Employer Member ID)

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Employee Open Enrollment System

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Employee Open Enrollment System

button to enter the website

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Employee Open Enrollment System

The system will open up to show the current active plans. If you are not enrolled in a plan it

You can change plans offered by your employer and change your coverage (i.e. single to employee/spouse). Review to add or drop new dependents before you change coverage (see instructions on pages 9-11)

Click the drop down button to see the

options available by your employer through health,

dental and vision.

You cannot make changes to

voluntary life insurance online.

See your employer for additional instructions.

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Employee Open Enrollment System

You can print a report before you change benefits.

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Employee Open Enrollment System

You can update your address, work and home telephone numbers

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Employee Open Enrollment System

Click this button to view current dependents

Click this button to add a dependent

Click this box to edit dependent information (name)

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Employee Open Enrollment System

Add Dependent

You must add SS #, first name, middle initial, type of dependent (child, spouse or domestic partner), sex and date of birth (last name is defaulted to the employees last name).

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Employee Open Enrollment System

Edit Dependent information

You can edit SS #, name, sex, date of birth and date of marriage (last name is defaulted to the employees last name).

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Employee Open Enrollment System

Make sure you save any changes you make to your benefits

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Employee Open Enrollment System

Sample The dependent now enrolled in medical coverage effective July 1.

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