Faculty Open Enrollment 6/19/2023 - 8/16/2023

Changes to SISC Medical Plan are effective 10/1/2023
Changes to Dental/Vision Plan are effective 1/1/2024
 
The following forms are required. Please complete and return to Human Resources:
  1. Open Enrollment Checklist
  2. The ACA (Affordable Care Act) Form
  3. Enrollment Plan Selection Forms for Medical
  4. Enrollment Plan Selection Forms for Dental
  5. Enrollment Plan Selection Forms for Vision 

If you are adding a spouse/domestic partner to your SISC medical, dental or vision coverage: You must also complete the appropriate membership change form (medical, dental, and/or vision) AND submit two documents: a copy of the Marriage Certificate/Domestic Partnership paperwork and a copy of your 2022 Tax Return. These documents are required.

If you are adding a child(ren) to your SISC medical, dental or vision coverage: You must also complete the appropriate membership change form (medical, dental, and/or vision) and submit a copy of the child’s birth certificate. These documents are required.

If you are part-time and declining all coverage: Please complete the Declination of Coverage form.


Key Plan Information:

 

Additional Plan Information: