The It's Your Choice enrollment period for health and dental insurance for 2012 will be:

October 3, 2011 - October 28, 2011.

The intent of this site is to save paper. To that end, we encourage employees to use this site for reference rather than printing this material.

The applications for enrollment or changes in coverage are the only items that need to be printed, completed and returned to Human Resources.

Please read before making health insurance changes online!

• Memo: Dual Choice Health Insurance Enrollment (PDF)
• It's Your Choice: Decision Guide (PDF)
• It's Your Choice: Reference Guide (PDF)
• ETF: Group Health Insurance for Members Website
• ETF: It's Your Benefit Newsletter (PDF)
• Frequently Asked Questions

• Health Insurance Premiums (PDF)
• E-Health Insurance Application Submission (PDF)
• Health Insurance Application/Change Form (PDF)
  • Sign and submit to Human Resources Department, Rm 501, CCB
• Imputed Income Information
  • Dental (PDF)
  • 2012-w-contrib (1020) (PDF)
  • 2012-w-contrib (1525) (PDF)
  • 2012-wo-contrib (PDF)

• Getting Started with Domestic Partner Benefits (PDF)
• Affidavit of Domestic Partnership (PDF)
• Domestic Partner Benefits (PDF)
• IRS Tax Information on Qualifying Children (PDF)

• Memo: Delta Dental Insurance Enrollment (PDF)
• Delta Dental Coverage (PDF)
• Delta Dental Application (PDF)
  • This form is "print only" and cannot be filled in on-line.
  • Submit to Human Resources Department, Rm 501, CCB
• Checkup Plus Plan (PDF)
• Evidence-Based Integrated Care Plan (EBICP) (PDF)
• Evidence-Based Integrated Care Plan (EBICP)-2 (PDF)
• Finding a Network Dentist (PDF)