What to do if...
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What You Want To Do |
Which Form(s) You Need to Complete & Submit |
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MEDICAL: |
Keep exactly the same coverage |
Nothing |
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Elect medical for the first time |
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Add/drop a dependent |
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Go from HMO to PPO or PPO to HMO plans |
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Drop medical |
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Enroll in Blue Medicare
|
Blue Medicare Enrollment Form | |
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Waive medical (and you currently waive medical) |
Nothing |
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Drop Vision |
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DENTAL: |
Keep exactly the same coverage | Nothing |
| Elect medical for the first time | Dental Enrollment Form | |
| Add/drop a dependent | Dental Change Form | |
| To switch from current option to another option (DMO, DPO, DPR) |
Dental Change Form | |
| Drop Dental | Dental Change Form | |
| VISION: | Keep exactly the same coverage | Nothing |
| Elect medical for the first time | Vision Enrollment/Change Form | |
| Add/drop a dependent | Vision Enrollment/Change Form | |
| Drop Vision |
Vision Enrollment/Change Form | |
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FLEXIBLE SPENDING ACCOUNTS |
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LIFE: |
Keep exactly the same coverage |
Nothing |
| Increase Supplemental Amount | Evidence of |
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Change a beneficiary |