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2008 Open Enrollment

Some links are large files and may take a few minutes to open.

STEP 1.

Complete the Benefits Bank Allocation form.

This form is MANDATORY for all full-time employees, even if you are not making any changes to your coverage. If you have funds to contribute to the flexible spending account, under line 10 (line 8 for Domestic Partner form), please specify whether the allocation is for health care reimbursement or dependent care reimbursement or a combination of the two.

For forms and rate information click on links below.

• Benefits Bank Allocation Form
• Benefits Bank Allocation Form with Domestic Partner

STEP 2.

Complete the EBA&M (Flexible Spending) Employee Enrollment form.

This form is also MANDATORY for all full-time employees. Any funds indicated on line 10 (line 8 for Domestic Partner form) of your Benefits Bank Allocation form must be listed here. To calculate the amount per pay period, multiply the amount from line 10 (line 8 for Domestic Partner form) of the Benefits Bank Allocation form by 12 (for 12 months in a year) and divide by 26 (for 26 pay periods). Please sign under the Authorization Section to complete your enrollment. If you do not wish to contribute any funds, please sign the bottom of the form declining participation.

For enrollment form and plan information click on links below.

• Flexible Spending Plan Information
• Flexible Spending Plan Brochure
• Flexible Spending Employee Enrollment Form

STEP 3.

Changes to Medical, Dental and/or Vision plans.

If you wish to change/add/drop a medical plan or the dental plan, or add/delete a dependent on a medical plan or the dental plan, please complete the corresponding Kaiser, Blue Cross and/or MetLife enrollment form. Changes to vision must only be noted on the Benefits Bank Allocation form.

For forms and plan information click on links below.

• Blue Cross HMO Plan Information
• Blue Cross HMO Enrollment Form
• Blue Cross PPO Plan Information
• Blue Cross PPO Enrollment Form
• Blue Cross Change of Information Form
• Kaiser Plan Information
• Kaiser Enrollment Form
• MetLife Dental Plan Information
• MetLife Dental Enrollment Form
• VSP Plan Information

STEP 4.

To waive AS sponsored coverages.

If you choose to waive AS sponsored medical or dental coverage and have a medical or dental plan not sponsored by AS, please submit a current copy of your identification card for each plan.

STEP 5.

Please complete and return all required enrollment material to the

AS Business Office
Attn: Victoria Elderp
NO LATER THAN
December 13, 2007

Need assistance?

Please contact Victoria Elder by e-mail at victoria.elder@sdsu.edu,
by phone at ext. 43243
or Tara Slaughter by e-mail at tara.slaughter@sdsu.edu,
by phone at ext. 44001
at any time during the open enrollment period.

• Benefits Bank Allocation Form
• Benefits Bank Allocation Form with Domestic Partner
• Flexible Spending Plan Information
• Flexible Spending Plan Brochure
• Flexible Spending Employee Enrollment Form
• Blue Cross HMO Plan Information
• Blue Cross HMO Enrollment Form
• Blue Cross PPO Plan Information
• Blue Cross PPO Enrollment Form
• Kaiser Plan Information
• Kaiser Enrollment Form
• MetLife Dental Plan Information
• MetLife Dental Enrollment Form
• VSP Plan Information