Enrollment Forms
Enrollment Forms are now located under the Frequently Used Forms
page.
Add dependents outside of Open Enrollment
Dependents must be added within 30 days of a qualifying event,
such as marriage, birth, registered domestic partner or loss of
coverage. Employee must complete a new enrollment along with
required documentation.
2023 Rate Sheets
Effective January 1, 2023 - December 31, 2023
2023 SEIU Early 50% Rates
2023 SEIU Over 65 Retiree Rates
2023 SEIU Over 65 50% Retiree Rates
2024 Rate Sheets
Effective January 1, 2024 – December 31, 2024
2024 SEIU/Teamsters Early Retiree Rates
2024 SEIU/Teamsters Early 50% Rates
2024 SEIU/Teamsters Over 65 Retiree Rates
2024 SEIU/Teamsters Over 65 50% Retiree Rates
Dental Plan
Delta Dental Information