Open Enrollment Information
Health, Benefits, & Employee Services (HBE)
Phone: (505) 844-4237
Enroll Online - To enroll or disenroll yourself and Class I Dependents
Domestic Partner - To enroll or disenroll a Same-Sex Domestic Partner and/or Domestic Partner Dependent in Medical, Dental and Vision Coverage
Class II Dependent - To disenroll a Class II Dependent (enrollment for new Class II dependents is closed)
Employees can use the web enrollment system to do the following:
Useful information about the web based application:
If you want to add a same-sex domestic partner or a dependent of your domestic partner during Benefits Choices 2009 Open Enrollment, you must do so outside of the web based open enrollment application. To enroll your same-sex domestic partner or a domestic partner dependent in coverage under your UHC Premier PPO Plan, UHC Standard PPO Plan, CIGNA In-Network Plan, Kaiser Permanente HMO Plan, Dental Care Plan, or Vision Care Plan, you must submit the required documents as outlined below.
To enroll your Same-Sex Domestic Partner or your Domestic Partner Dependent, you must submit an Employee Health Plan Benefits Enrollment/Disenrollment Packet, Domestic Partner Affidavit, provide proof of your family relationship, and supporting domestic partnership documents, and return all documents to HBE Customer Service Center, MS 1463 or fax to 505-844-7535 by 5 pm (MST), November 10, 2008.
1. Employee Health Plan Benefits Enrollment/Disenrollment Packet and Affidavit of Domestic Partnership Forms
Complete the Employee Health Plan Benefits Enrollment/Disenrollment Packet (SF4400-PKG) and Affidavit of Domestic Partnership (SF4400-DPA)
Note: You and your domestic partner must sign the Affidavit of Domestic Partnership form, and the form must be notarized.
2. Proof of Family Relationship
If your domestic partner has a legally adopted child, you will need to submit copies of the placement agreement and/or final adoption papers.
3. Supporting Domestic Partnership Documents
If you enroll a domestic partner and/or a domestic partner's dependent, you will also be asked to provide supporting documentation of your domestic partnership that must include a copy of one of the following items:
Notes: You can only add a dependent to your coverage outside of Open Enrollment based on an eligible mid-year election change event (e.g., birth, adoption). If you add a dependent during Open Enrollment, coverage will become effective January 1, 2008.
If you do not enroll a dependent because the dependent has other medical coverage and your dependent involuntarily loses eligibility for that coverage, you may be able to enroll the dependent in your medical plan provided that you request enrollment within 31 calendar days after the other coverage ends.
To disenroll your Domestic Partner and/or Domestic Partner dependent, you must complete the Employee Health Plan Benefits Enrollment/Disenrollment Packet (SF4400-PKG) and return it to HBE Customer Service Center, MS 1463 or fax to 505-844-7535 by 5 pm (MST), November 10, 2008.
Class II Dependents - Enrolling
Effective January 1, 2009 – No new Class II Dependents can be enrolled in any of the Sandia medical plans. All eligible Class II Dependents currently enrolled under a medical plan will be allowed to continue enrollment.
Disenrolling Class II Dependents
To enroll or disenroll a Class II Dependent during Benefits Choices 2008 Open Enrollment, you must do so outside of the web based open enrollment application by completing all required forms included in the Corporate Form Application for Sandia Medical Care Plan Coverage for Class II Dependents SF 4400-CTD
How to Disenroll
To disenroll your Class II dependent, you must complete the Employee Health Plan Benefits Enrollment/Disenrollment Packet (SF4400-PKG) and return it to HBE Customer Service Center, MS 1463 or fax to 505-844-7535 by 5 pm (MST), November 10, 2008.