ANTHEM AND
MSMA DENTAL OPEN ENROLLMENT
If you have any questions, please contact Hollie Linscott at the Central Office. All forms are due by June 9, 2023.
The Anthem Booklet, Dental Plan Summary, and Rate Sheets are provided for your information.
The following forms require your action:
The Anthem and MSMA Dental Open Enrollment Change Form
Pre-Tax Insurance Form
Dependent Care Reimbursement and Salary Reduction
Forms are regulated by the IRS so it is important that employees complete the correct form. To determine whether you are a school year or year round staff; use this information:
Teachers and School Year Staff:
Teachers, Nurses, Guidance, Social Workers, Speech, OT, PT, Ed Techs, Secretaries, Food Service, Bus Drivers, Van Drivers & BusAides and anyone else that starts a new work year in September.
Administrator & Year Round Staff:
Administrators, Directors, Central Office Staff, Custodians, Maintenance and anyone else that starts a new work year in July.
REQUIRED: After Reviewing the Anthem and MSMA Dental Information, use the form below to indicate if you wish to make any changes to your current plan(s). If you answer "Yes", you will be asked to list any change(s) you are going to make. This will ensure you are emailed the correct forms.
Pre-Tax Insurance Forms
Please print the form, fill it out and return it to Hollie at the Central Office in Union by inter-office mail. Again, if you are unsure of which form to complete, see the guide above for school year vs calendar year employees.
Medical and Dependent Care Reimbursement and Salary Reduction Agreement Forms
Please print the form, fill it out and return it to Hollie at the Central Office in Union by inter-office mail.
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