Oracle Advanced Benefits: Open Enrollment - Ohio · PDF fileOracle Advanced Benefits: Open Enrollment Document ID: OAB2_01 Effective Date: 04/11/2016 Page 2 VPFA/Communication and

Title: Oracle Advanced Benefits: Open Enrollment

Document ID: OAB2_01

Replaces: Date Modified: 04/11/2016

Purpose: The purpose of this document is to assist OHIO employees with Open Enrollment, the annual opportunity to make changes to benefits coverage plan options (April 11 – 29). Benefit changes and elections made during Open Enrollment will take effect on July 1, 2016.

For Questions Contact: Employee Service Center (ESC) at 740.593.1636 or [email protected].

Table of Contents

OPEN ENROLLMENT ............................................................................................................................................... 2

LINKS TO NEW BENEFITS OPTIONS & DESCRIPTIONS ............................................................................................. 2

SYSTEM REQUIREMENTS ....................................................................................................................................... 4

MY PERSONAL INFORMATION: OPEN ENROLLMENT .............................................................................................. 5

Log in to My Personal Information (MPI): ............................................................................................................. 5

VIEW CURRENT BENEFITS ...................................................................................................................................... 8

DEPENDENTS & BENEFICIARIES ......................................................................................................................................... 9 SPECIAL CIRCUMSTANCES ................................................................................................................................................ 9 REMOVE A CONTACT..................................................................................................................................................... 10 UPDATE AN EXISTING CONTACT ...................................................................................................................................... 11 ADD ANOTHER PERSON ................................................................................................................................................. 12

COMPLETE OPEN ENROLLMENT ........................................................................................................................... 14

UPDATE BENEFITS ........................................................................................................................................................ 14 Athens Campus Parking Opt-out ......................................................................................................................... 15 Helpful Definitions ............................................................................................................................................... 16

DEPENDENT SELECTION ................................................................................................................................................. 17 If the Contact that You Added Does Not Display................................................................................................. 18

BENEFICIARY SELECTION ................................................................................................................................................ 19 ADDITIONAL DOCUMENTATION ....................................................................................................................................... 21

Verification of Dependents ................................................................................................................................. 21 Beneficiary ........................................................................................................................................................................ 21 Supplemental Life Insurance Increase of More than $20,000 .......................................................................................... 21

CONFIRMATION STATEMENT .......................................................................................................................................... 22

OPT OUT OF PARKING (ATHENS CAMPUS ONLY) ................................................................................................. 23

OPT OUT OF EMPLOYEE PARKING FEE .............................................................................................................................. 23

ONLINE FORMS .................................................................................................................................................... 25

mailto:[email protected]

Oracle Advanced Benefits: Open Enrollment Document ID: OAB2_01

Effective Date: 04/11/2016

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VPFA/Communication and Training

OPEN ENROLLMENT

Open Enrollment is the annual opportunity OHIO benefits-eligible employees have to make changes to their benefits coverage plan options including: increasing/decreasing coverage; adding/dropping covered dependents; and enrolling in flexible spending accounts.

ATTN: THE 2016 ANNUAL BENEFITS OPEN ENROLLMENT PERIOD IS APRIL 11 THROUGH APRIL 29.

The 2016 Annual Benefits Open Enrollment period is April 11 through April 29. Benefit changes and elections made during Open Enrollment will take effect on July 1, 2016. All OHIO benefits-eligible employees must participate in the 2016 Open Enrollment to select new vision and short-term disability plan options. Failure to participate in Open Enrollment will result in the continuance of current medical, dental, and life insurance enrollments only. All other benefit coverages (including vision, flexible spending accounts, and short-term disability) will be dropped unless selected during Open Enrollment.

ATTN: ALL OHIO BENEFITS-ELIGIBLE EMPLOYEES MUST PARTICIPATE IN THE 2016 OPEN ENROLLMENT TO SELECT

NEW VISION AND SHORT TERM DISABILITY PLAN OPTIONS.

LINKS TO NEW BENEFITS OPTIONS & DESCRIPTIONS

1. Visit OHIO’s Benefits Open Enrollment website: https://www.ohio.edu/hr/benefits/healthcare/openenrollment.cfm

2. To view the 2016-17 Benefits Open Enrollment Guide, click the link for your Employment Group.

3. The guide will display in your default browser. Under Bookmarks (left side of the screen), click the desired Subject to skip to/review that section of the guide. NOTE: If you are using

https://www.ohio.edu/hr/benefits/healthcare/openenrollment.cfm

Document ID: OAB2_01 Oracle Advanced Benefits: Open Enrollment


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Google Chrome, click the Bookmarks icon (top right corner) and click the desired Subject to skip to/review that section of the guide.



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SYSTEM REQUIREMENTS

OIT highly recommends using Internet Explorer 9 or higher to access Oracle e-Business Suite and/or My Personal Information (MPI). The latest version of Java is also required.

WARNING: IN MY PERSONAL INFORMATION (MPI), YOUR BROWSER’S BACK BUTTON WILL NOT NAVIGATE TO THE PREVIOUS SCREEN. YOU WILL RECEIVE AN ERROR MESSAGE. CLICK THE APPROPRIATE TAB/LINK/BUTTON TO NAVIGATE TO

THE DESIRED SCREEN.



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MY PERSONAL INFORMATION: OPEN ENROLLMENT

Open Enrollment will be offered online via My Personal Information (MPI). Accessing the system will allow you to:

Review current coverages and make necessary changes

Select a medical and prescription drug plan

Select one of the two new vision plans

Enroll in the dental plan

Elect flexible spending accounts

Enroll in the new short term disability plan

Enroll in supplemental and dependent life insurance plans

Log in to My Personal Information (MPI):

1. Visit: https://www.ohio.edu/ebiz/ebiz.html

2. Click My Personal Information.

3. Click My Personal Information.

https://www.ohio.edu/ebiz/ebiz.html



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4. Enter your OHIO ID and Password and click Login.

5. Click the + to expand your My Personal Information folder.



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6. Click Self Service Benefits.



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VIEW CURRENT BENEFITS

When you access Self Service Benefits, your current Benefit Selections and Rate Details as well as Covered Dependents and Beneficiaries will display.

1. Please read the Legal Disclaimer. Click the radio button next to Accept.

2. Click Next.



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Dependents & Beneficiaries

Dependents and Beneficiaries provides a listing of individuals currently linked to your record as “contacts.” Contacts include your health care eligible dependents as well as life insurance beneficiaries. A qualified dependent is a legally married spouse, domestic partner for which you have completed a domestic partner affidavit with University Human Resources; children under the age of 26 including adopted children, stepchildren, children of domestic partners, children for which you are the legal guardian, and disabled children who have been approved by Anthem.

A beneficiary can be any individual(s). NOTE: You may also name trusts, estates or other non-individuals, however, these must be documented on a paper Beneficiary Designation Form:

https://www.ohio.edu/hr/forms/upload/Life_Ins_Beneficiary_Dearborn.pdf

ATTN: A PAPER BENEFICIARY DESIGNATION FORM IS ALSO REQUIRED IF YOU DO NOT KNOW YOUR BENEFICIARY’S

SOCIAL SECURITY NUMBER (SSN). USE ONLINE ENROLLMENT FOR EVERYTHING BUT DESIGNATING BENEFICIARY. YOU

MAY SEND DOCUMENTATION VIA CAMPUS MAIL TO UNIVERSITY HUMAN RESOURCES’ EMPLOYEE SERVICE CENTER

(ESC), 107 HRTC. IF YOU PREFER TO HAND DELIVER YOUR DOCUMENTATION, DELIVER TO 103 HRTC (FRONT DESK

AREA).

Special Circumstances

The following dependents and/or beneficiaries cannot be added in Self Service Benefits at this time. Please contact University Human Resources’ Employee Service Center at 740.593.1636 if any of the situations below are applicable to the dependent/beneficiary who you would like to add or update:

They are a current or former Ohio University employee

If you receive a duplicate record error

You wish to add a dependent outside of the Open Enrollment period (we will implement enhanced functionality later this summer to handle qualifying life events outside of the Open Enrollment period).

1. On the Dependents and Beneficiaries page, review your dependent and beneficiary information. If you need to update your dependents and/or beneficiaries, see “Update an Existing Contact.” If you need to add a dependent and/or beneficiary, see “Add Another Person.”

2. If your dependent and beneficiary information is correct, click Next.

3. Click the Current Benefits tab. Under The following is an overview of your current benefits enrollments, click the drop-down menu to select the effective date of the benefits you would like to review and click Go.




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4. Your benefit enrollments, covered dependents, and beneficiaries for the period that you

selected will display.

Remove a Contact

Dependents and Beneficiaries provides a listing of individuals currently linked to your record as “contacts.” To remove a contact from your record, please contact University Human Resources’ Employee Service Center at 740.593.1636.



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Update an Existing Contact

Review your list of dependents and beneficiaries.

1. To update information for an existing contact, in the Update column, click the Pencil icon

next to the appropriate person’s name.

2. Under Name and Relationship, update the contact’s information. Fields marked with an asterisk (*) are required.

3. Click the drop-down menu to select the appropriate Relationship. NOTE: A qualified dependent for health care coverage has to be one of the following: spouse, domestic partner, child, adopted child, stepchild, legal guardian, domestic partner child, domestic partner adopted child, domestic partner legal guardian. A beneficiary can be any relationship type available.

4. Update the contact’s Legal Name in Proper Case (not UPPERCASE and not lowercase). Example: Rufus Bobcat (capitalize “R” and “B.”)



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5. Under Address Information, update the contact’s Address, or click the Shared Residence checkbox if the contact resides with you.

6. Under Miscellaneous Information, verify and/or update the contact’s information. When entering Social Security Number, include dashes.

7. If you are enrolling a spouse/domestic partner in medical coverage, you must specify if this person has access to health care coverage from his or her employer. If they have access to health care, click the checkbox.

8. If they are enrolled in their employer’s health care plan, enter their Employer Name.

9. Click Apply.


Add Another Person

ATTN: SOCIAL SECURITY NUMBER (SSN) IS REQUIRED FOR NEW DEPENDENTS. IF YOU DO NOT KNOW YOUR NEW

DEPENDENT’S SSN, THE PAPER 2016-17 BENEFITS ENROLLMENT FORM IS REQUIRED. YOU MUST ALSO COMPLETE

ANTHEM’S SSN EXCEPTION FORM. SEE “ONLINE FORMS.” YOU MAY SEND DOCUMENTATION VIA CAMPUS MAIL TO

UNIVERSITY HUMAN RESOURCES’ EMPLOYEE SERVICE CENTER (ESC), 107 HRTC. IF YOU PREFER TO HAND DELIVER

YOUR DOCUMENTATION, DELIVER TO 103 HRTC (FRONT DESK AREA).

To add a dependent and/or beneficiary, you must create a contact.

1. Under Dependents and Beneficiaries, click the Add Another Person button. Fields marked with an asterisk (*) are required.



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2. Under Name and Relationship, click the drop-down menu to select the appropriate Relationship. NOTE: A qualified dependent for health care coverage has to be one of the following: spouse, domestic partner, child, adopted child, stepchild, legal guardian, domestic partner child, domestic partner adopted child, domestic partner legal guardian. A beneficiary can be any relationship type available.

3. Enter the contact’s Legal Name in Proper Case (not UPPERCASE and not lowercase). Example: Rufus Bobcat (capitalize “R” and “B.”)

4. Under Address Information, enter the contact’s Address, or click the Shared Residence checkbox if the contact resides with you.

5. Under Miscellaneous Information, enter the contact’s information.

Click the dropdown menu to select Gender.

When entering Social Security Number, include dashes.

Click the Calendar icon to select the contact’s Date of Birth or manually key in the date in the following format: DD-MMM-YYYY. Example: 12-JUN-2005



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6. If you are enrolling a spouse or domestic partner in medical coverage, you must specify if this person has access to health care coverage from his or her employer. If they have access to health care, click the checkbox. If they are enrolled in their employer’s health care plan, enter their Employer Name.

ATTN: EMPLOYEES WILL BE CHARGED AN ADDITIONAL SPOUSE/PARTNER PREMIUM OF $50 PER MONTH FOR HEALTH

CARE COVERAGE FOR THEIR SPOUSE/PARTNER IF THEY ARE OFFERED HEALTH COVERAGE THROUGH THEIR EMPLOYER, BUT ARE NOT ENROLLED. THIS ADDITIONAL PREMIUM IS NOT APPLICABLE IF THE SPOUSE/PARTNER IS AN OHIO

UNIVERSITY EMPLOYEE.

7. Click Apply. The person you added will now display in your Dependents and Beneficiaries list.

8. Repeat (steps 1-7) to add additional dependents and/or beneficiaries.


COMPLETE OPEN ENROLLMENT

Update Benefits

1. To make your new benefit elections for the upcoming fiscal year, verify the Benefits Enrollment tab is selected. An overview of your current benefits enrollments will display.



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Athens Campus Parking Opt-out

ATTN: IF YOU OPTED OUT OF PARKING LAST YEAR, IT WILL CARRY OVER. YOU DO NOT HAVE TO OPT OUT AGAIN FOR

THE UPCOMING YEAR.

IF AN EMPLOYEE IS OPTED OUT AND WISHES TO OPT IN AND OBTAIN A PARKING PERMIT, CONTACT PARKING SERVICES

AT 740.593.1917 (OFFICE HOURS ARE MONDAY – FRIDAY FROM 7:30 AM UNTIL 4:30 PM) FOR SPECIFIC

INSTRUCTIONS.

2. All benefits-eligible OHIO employees of the Athens campus will have the $150 annual parking fee deducted from their paychecks unless the employee opts out of parking during Open Enrollment. Opting out of the parking fee will result in forfeiting your parking permit. To “opt out” of the $150 annual parking fee, click the Athens Campus Parking Opt-out link. This link will redirect you to Parking Services website. NOTE: If you opted out of parking last year, it will carry over. You do not have to opt out again for the upcoming year. For additional information, see “Opt Out of Parking (Athens Campus Only).”

3. To make changes to your benefits coverage, click the Update Benefits button (top right).



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Helpful Definitions

Column Definition

Update To update information for an existing contact, click the Pencil icon

next to the appropriate person’s name.

Details Click the + or Show to expand the view.

Plan Plan Type (Medical, Dental, Vision, Basic Life Insurance, Supplemental Life Insurance, Flexible Spending Accounts, and Employee Assistance Plan, etc.)

Options Options available for each Plan Type (Employee, Employee + One, Employee + Spouse, Employee + Family, etc.)

Details Click the icon to review plan options and descriptions. This will open in a new window. Depending on your browser, it may open multiple windows. Click your browser in the taskbar at the bottom of the screen.

Select Each checkbox is a toggle button. Click once to select the checkbox. Click the checkbox again to deselect it. Only one checkbox may be selected for each Plan Type.

Coverage/Amount The amount of coverage that you are electing. Used for Flexible Spending Accounts, Life Insurances, and Disability plans.

Employee Pre-tax Premium

The amount that the employee pays for the tax-free benefit per pay period. Deductions are prior to taxes being calculated.

Employee After-tax Premium

The amount that the employee pays for the taxable benefit per pay period. Deductions are after taxes are calculated.

Employee Imputed Income

The amount per pay period that is added as taxable earnings for health coverage of a non-taxable dependent.

Employer Premium OHIO’s cost per pay period for your benefit enrollment.



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ATTN: ONLY BENEFITS THAT YOU ARE ELIGIBLE FOR WILL DISPLAY ON YOUR PAGE.

4. Under each Plan Type, next to the desired option, click the checkbox to select your benefit

choice. Each checkbox is a toggle button. Click once to select the checkbox. Click the

checkbox again to deselect it. Only one checkbox may be entered for each Plan Type.

5. If you wish to decline coverage, next to Waive, click the checkbox for the appropriate Plan

Type.

Benefits that do not have a cost for employees cannot be waived (Employee Assistance

Plan)

If enrolling in the Supplemental Life Plan or a Flexible Spending Account, in the

Coverage/Amount column, enter the Coverage Amount. For additional information,

hover your mouse over the icon.

ATTN: VISION AND SHORT TERM DISABILITY WILL DEFAULT TO WAIVE. IF SELECTING THESE PLANS, YOU MUST CLICK

THE WAIVE CHECKBOX TO DESELECT IT, THEN CLICK THE DESIRED OPTION.

6. After selecting your coverage options and amounts for each Plan Type, click Next.

WARNING: ONLY ONE CHECKBOX MAY BE SELECTED FOR EACH PLAN TYPE.

Dependent Selection

If you created a contact in order to add a dependent and/or beneficiary, the contact will display here, however, you still must specify your election for his or her coverage.

WARNING: IF THE CORRECT RELATIONSHIP TYPES ARE NOT USED WHEN ADDING A NEW CONTACT, THEY MAY NOT DISPLAY. EXAMPLE: CONTACTS WITH A

RELATIONSHIP TYPE OF “SON” OR “DAUGHTER” WILL NOT BE SHOWN ON THE COVER DEPENDENTS PAGE. “CHILD,” “ADOPTED CHILD,” AND “STEP CHILD” ARE

APPROPRIATE RELATIONSHIP TYPES THAT SHOULD BE USED INSTEAD.



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7. Under Cover Dependents, next to the appropriate person’s name, click the checkbox to indicate dependents you elect to cover for each Plan Type. Each checkbox is a toggle button. Click once to select the checkbox. Click the checkbox again to deselect it.

If the Contact that You Added Does Not Display

1. If the contact that you added does not display, click the Add Dependents button at the bottom of the page. You will return to the Dependents and Beneficiaries page.

2. To update information for an existing contact, in the Update column, click the Pencil

icon next to the appropriate person’s name.

3. Correct the Relationship Type. NOTE: A qualified dependent for health care coverage has to be one of the following: spouse, domestic partner, child, adopted child, stepchild, legal guardian, domestic partner child, domestic partner adopted child, domestic partner legal guardian. A beneficiary can be any relationship type available.

4. Click Apply.

5. Click Next. You will return to the Cover Dependents page where the dependent now displays.



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8. Click Next.

Beneficiary Selection

9. Under Beneficiary Selection, update your beneficiary designations by entering the percentage of benefit for each beneficiary listed. Enter the percentage of benefit for both Primary and Contingent beneficiaries.

Why am I being asked to provide beneficiaries multiple times?

If you enroll in the supplemental life insurance plan, you will need to designate beneficiaries for both the basic life insurance plan and the supplemental life insurance plan. These plans are administered separately, so you may choose to designate different beneficiaries on each plan.



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Additionally, if you have elected to increase your supplemental life insurance coverage by more than $20,000, you will need to designate beneficiaries for both your elected coverage amount as well as your interim coverage amount. Your interim coverage amount will be equal to your current coverage amount + $20,000. Once the Evidence of Insurability form is received and approved by the life insurance company, your elected coverage amount will be applied. The beneficiaries on both your elected coverage as well as your interim coverage must be the same since these are the same plan.

The Primary Beneficiary is the person or persons who will receive the benefits in the event

of the insured's death. Proceeds will be divided in equal shares if multiple primary

beneficiaries are named, unless otherwise indicated. If percentages are listed, the total must

equal 100%.

The Contingent Beneficiary is the person or persons who will receive the benefits if the

primary beneficiary(ies) is not living at the time of the insured's death.

WARNING: EACH LISTING OF PRIMARY BENEFICIARIES MUST EQUAL 100% AND EACH LISTING OF CONTINGENT BENEFICIARIES MUST EQUAL 100%.

10. Click the Recalculate button to ensure totals equal 100%. NOTE: While a change in life insurance coverage will not be effective until July 1, 2016, your beneficiaries will be updated immediately.

11. Click Next.

REMINDER: If you prefer to designate a non-person beneficiary such as an estate, trust, organization, etc. you must submit a paper Beneficiary Designation Form and set all of the percent values to zero. A paper beneficiary form is also required if you do not know your beneficiary’s Social Security Number (SSN) since the system will not allow you to add a beneficiary without a SSN.





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Additional Documentation

Verification of Dependents

Some benefit elections made during the Open Enrollment period require additional documentation. University Human Resources requires the documentation for enrolling dependents in health and welfare benefits. Existing employees will need to furnish such paperwork if/when making changes to an enrollment choice, such as adding dependents due to marriage. Required documentation must be submitted to University Human Resources no later than the last date of your Open Enrollment period (April 29). Failure to provide required documentation may result in a denial of coverage for eligible dependents.

The following website provides a listing of acceptable documents: https://www.ohio.edu/hr/benefits/healthcare/verification.cfm

If enrolling new dependents in medical, dental or vision coverage, you must provide dependent verification as indicated (birth certificate, marriage certificate, domestic partner affidavit, etc.). You may send documentation via campus mail to University Human Resources’ Employee Service Center (ESC), 107 HRTC. If you prefer to hand deliver your documentation, deliver to 103 HRTC (front desk area).

ATTN: IF YOU ARE ADDING A DEPENDENT THAT YOU HAVE NOT PREVIOUSLY COVERED, YOU MUST SUBMIT PROOF OF

ELIGIBILITY (EXAMPLES: COPY OF BIRTH CERTIFICATE, MARRIAGE CERTIFICATE, DOMESTIC PARTNER AFFIDAVIT)

DIRECTLY TO UNIVERSITY HUMAN RESOURCES NO LATER THAN THE LAST DATE OF YOUR OPEN ENROLLMENT PERIOD.

Beneficiary

A beneficiary can be any individual(s). NOTE: You may also name trusts, estates or other non-individuals, however, these must be documented on the paper Beneficiary Designation Form:


Supplemental Life Insurance Increase of More than $20,000

If you increase your Supplemental Life Insurance more than $20,000 during Open Enrollment, you

will need to complete an Evidence of Insurability Form:

https://www.ohio.edu/hr/forms/upload/EOI_Dearborn_policyno.pdf NOTE: This form is only

required if increasing by more than $20,000.

https://www.ohio.edu/hr/benefits/healthcare/verification.cfm


https://www.ohio.edu/hr/forms/upload/EOI_Dearborn_policyno.pdf



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Confirmation Statement

Saving or printing a copy of the Confirmation Statement indicates that you agree to be responsible

for the security of the sensitive data stored in the confirmation statement and take responsible

measures to protect this data/file.

12. On the Confirmation Statement, review your elections to verify for accuracy.

13. To print your Confirmation Statement, click the Confirmation Statement button.

14. You will be asked if you would like to open or save the file. Click Open.

15. From Adobe Acrobat Reader’s File menu, click Print. Specify the desired printer Properties and click Print. Close Adobe Acrobat Reader.

16. To make changes to your benefits elections, click the Back button.

17. To complete the enrollment process, click Logout.



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REMINDER: You will have the option to make further changes to your benefit coverages, but only until the Open Enrollment period ends on April 29.

OPT OUT OF PARKING (ATHENS CAMPUS ONLY)

ATTN: IF YOU OPTED OUT OF PARKING LAST YEAR, IT WILL CARRY OVER AND YOU WILL NOT HAVE TO OPT OUT AGAIN

FOR THE UPCOMING YEAR.

WARNING: THERE IS NO “OPT IN” PROCESS ONLINE. IF AN EMPLOYEE IS OPTED OUT AND WISHES TO OPT IN AND OBTAIN A PARKING PERMIT, THEY NEED TO CONTACT PARKING SERVICES AT 740.593.1917 (OFFICE HOURS ARE MONDAY –

FRIDAY FROM 7:30 AM UNTIL 4:30 PM) FOR SPECIFIC INSTRUCTIONS.

Opt Out of Employee Parking Fee

Employees may “opt out” of the parking fee. The deadline to opt out of parking for the next fiscal year is the end of the benefits Open Enrollment (April 29). It is imperative that employees opt out by April 29, or fees will be deducted from their pay checks. The frequency of this deduction and amount is determined by the number of pays received by the employee; the deduction for each employee will be $150 per year. Those who do not wish to pay the parking fee must return any valid University permit they have in their possession and parking on campus will only be available during the times in which the dark green and purple lots do not require a permit. Non-benefit eligible employees may choose not to obtain a permit, and no fees will be deducted because non-benefit eligible employees must pay at the time the permit is issued.



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Staff working shifts that are during times permits are not required (partially or fully) may choose to “opt out” of the parking fee and relinquish any parking permits in their possession. Staff who choose to do this because they work during a time in which permits are not required, must park within the lots only during the times in which a permit is not required.

1. To opt out of parking, visit: https://ohiou.t2hosted.com/cmn/index.aspx 2. Click the Manage My Parking Account link.

3. Enter your OHIO ID and Password and click Login.

4. Scroll down and click Employee Opt-Out.

5. Follow the prompts to opt out.

https://ohiou.t2hosted.com/cmn/index.aspx



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REMINDER: Open Enrollment is the annual opportunity OHIO employees have to make changes to their benefits coverage plan options including: increasing/decreasing coverage; adding/dropping covered dependents; and enrolling in flexible spending accounts. In compliance with Federal regulations, other than during the annual Open Enrollment period, employees may only change their benefits if a qualifying event occurs. Review the Qualifying Family Status web page for details regarding qualifying events.

ONLINE FORMS

You may send documentation via campus mail to University Human Resources’ Employee Service Center (ESC), 107 HRTC. If you prefer to hand deliver your documentation, deliver to 103 HRTC (front desk area).

Anthem SSN Exception Form: https://www.anthem.com/bydesign/noapplication/f3/s0/t0/pw_e195769.pdf?refer=ahpemployer

2016-17 Benefits Enrollment Form: https://www.ohio.edu/hr/forms/index.cfm#b

Beneficiary Designation Form: https://www.ohio.edu/hr/forms/upload/Life_Ins_Beneficiary_Dearborn.pdf

Evidence of Insurability Form: https://www.ohio.edu/hr/forms/upload/EOI_Dearborn_policyno.pdf

Domestic Partner Affidavit: https://www.ohio.edu/hr/upload/DP_Affadavit_2015.pdf

https://www.ohio.edu/hr/benefits/healthcare/family.cfm

https://www.anthem.com/bydesign/noapplication/f3/s0/t0/pw_e195769.pdf?refer=ahpemployer

https://www.ohio.edu/hr/forms/index.cfm#b


https://www.ohio.edu/hr/forms/upload/EOI_Dearborn_policyno.pdf

https://www.ohio.edu/hr/upload/DP_Affadavit_2015.pdf

Documents

Oracle Advanced Benefits: Open Enrollment - Ohio · PDF fileOracle Advanced Benefits: Open Enrollment Document ID: OAB2_01 Effective Date: 04/11/2016 Page 2 VPFA/Communication and