2021 NonPERS Active Open Enrollment

2021 Open Enrollment will begin on October 19, 2020 and end on November 6, 2020.

Plan changes are effective on January 1, 2021

Open enrollment is the time to:
Open Enrollment is available through Employee Self Service (ESS):
NOTE: If no changes are being made for the medical, dental and vision plans, you DO NOT need to take any action.  You will continue to keep your current medical, dental, and vision plans for the 2021 plan year.  We encourage all employees to login to Employee Self Service (ESS) to review their current benefits. Please refer to 2021 rate table for changes in the medical, dental, and vision plan premiums.


For complete information about negotiated benefits, please see your applicable Memorandum of Understanding or Management Resolution.

If you would like to make a plan change for 2021, please complete your online enrollment no later than 5:00 PM on November 6, 2020.

Flex Spending Accounts

Per IRS regulation, you must re-enroll in the Health Care Spending Account (HCSA) and/or Dependent Care Assistance Program (DCAP) each Plan Year.
 
In order to enroll in either HCSA or DCAP, you are required to complete your online enrollment by November 6, 2020.

Health Care Spending Account (HCSA): 
*Max 2021 annual contribution $2,750
      
HCSA Guide

Dependent Care Assistance Program (DCAP)
*Max 2021 annual contribution $5,000
DCAP Guide
 
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MEDICAL AND DELTACARE PMI DENTAL (HMO)

Age Limit: 26
Requirements: Upload original certified birth certificate via Employee Self Service (ESS).


Dependent Verification Form (PDF)

 
DELTA PREMIER DENTAL (PPO) AND VISION

Age Limit: 19 - 24
Requirements: Must be a) full-time student, b) receive more than one-half of support from employee and c) unmarried. Upload original certified birth certificate with dependent verification form via Employee Self Service (ESS).



Adding Domestic Partners

Please read the following Domestic Partner Information to see what the  requirements and documentations are to add a domestic partner to your health and/or dental benefits.

Be sure to complete the following forms during your online Open Enrollment.

Declaration of Domestic Partner Form (PDF)

IRC Section 152 Form (PDF)
 

Life Insurance


Life and Accidental Death & Dismemberment (AD&D) Insurance Enrollment 

Evidence of Insurability Form (PDF)
  • must be completed if employee is requesting new or additional coverage
  • must be completed if requesting coverage for dependents

Supplemental Life Insurance Plan Booklet (PDF)

Monthly Premium Rate Sheet (PDF)