Open Enrollment Benefit Information

2014-2015 Academic Year

Section 125 Form

DUE DATE: Friday, May 30, 2014

More information

All employees working half-time or more must…

  • make your selections about which benefits you will select for the new college year beginning July 1,
  • decide which dependents, if any, you wish to cover, and,
  • choose which plan(s) in which you wish to enroll.


  1.  Wednesday, April 16th: from 9:30 a.m.-12 noon and 1:15-3:30 p.m. You may complete your Section 125 form and do all your sign-ups or changes for insurance coverage at the annual Benefits Fair in the College Church Fellowship Hall.
  2. Friday, May 30th: your section 125 form and any insurance application forms are due to Vickie Miller in Human Resources.


ALL FORMS MUST BE COMPLETED AND SUBMITTED TO VICKIE MILLER BY Friday, May 30th: A new application or cancellation form is needed for any benefit in which you are changing coverage. Changing your Section 125 form is one step; a new application or cancellation is needed for the insurance company to know your change of coverage.

Many of the forms are available online from the HR forms page. Download them, fill them in, print them out, and return all forms to the Human Resources department by campus mail to Westlawn 103. You can also stop by the HR department anytime to pick up a form.

Come to the Benefits Fair for detailed information and help filling out the forms. To review your current benefits, please see the employee-elected deductions listed on your online Compensation Statement. We will also have a copy of your current Section 125 form available at the Benefits Fair.

Benefits Fair

You may do all your sign-ups at the Benefits Fair Wednesday, April 16th, from 9:30 a.m.-noon. and 1:15-3:30 p.m. in the College Church Fellowship Hall.

The Benefits Fair on April 16th will feature representatives of most of our benefit providers who can offer assistance in describing products and completing applications. In addition, representatives from TIAA-CREF and Mennonite Retirement Trust will be in attendance to facilitate account enrollment or answer employee questions. A Human Resources table will include Section 125 forms and answers to your open enrollment questions. We will have your current year Section 125 form available to compare. Please plan to visit each vendor on April 16th at the College Mennonite Church Fellowship Hall.

The following benefits are involved in Open Enrollment:

Health insurance

Employee premiums will depend on employee participation in the Wellness Program and how many of the 4 wellness goals have been met. Employees who choose to opt out of the Wellness Program will pay for 20% of the premium that the college normally pays for a single employee. Please see the Wellness Program for further details about the wellness goals.

The rates for 2014-15 have increased by approximately 6%.

Single Coverage
Full Family
 $0  $161.92  $443.60  $605.52
College  $505.63  $667.55  $505.63  $667.55
Total  $505.63  $829.47  $949.23  $1,273.07
*Contingent on meeting all wellness goals

In your coverage decision, remember that the rates above are gross deductions. The net cost to you will be 75-80% of these figures due to taking them out of your check pre-tax (tax free).

Dental insurance

The dental insurance rates have gone down for the 2014-2015 college year. Employees pay the full cost of these premiums.

Dental Monthly Premium Cost:

Plan 6b
Employee only  $21.10
Employee + 1 dependent  $48.40
Full Family  $90.10

Vision Service Plan

VSP offers two plans with 4 levels of employee and family coverage. These plans and monthly rates, paid by the employee, are outlined below. The rates are unchanged for the 2014-2015 college year.

Employee Empl + 1 Empl + Dependents Full Family
Plan B $8.41  $14.71  $14.47  $23.32
Plan C  $12.39  $20.88  $21.31  $34.36

Both plans offer coverage with a co-payment for an examination by an optometrist and new lenses/contacts once a year. Frames are covered up to $120 every year with Plan C and every two years with Plan B. Co-payments are $10 for an exam and $25 for glasses with standard lenses in Plan B, and $20 for both in Plan C. Contact lenses and certain lenses for glasses are discounted in price but not included in the $25 co-pay.

AFLAC Insurance

We offer 4 individual supplemental insurance products through AFLAC: Life, Accident, Cancer, and Specified Health Event (includes heart, stroke, kidney failure and other conditions). Premium costs are paid by the employee, and rates vary according to age and family coverage chosen. This insurance pays cash directly to the employee or beneficiary regardless of health or other insurance coverage. Please consult the AFLAC representative (Cheryl Miller, 875-1961) for further information, as well as to enroll and determine your premium amount.

Cancer Plus 30 insurance

You can continue your current coverage by checking the appropriate box on the Section 125 form, or change coverage. However, we are not enrolling new employees in this plan. You may want to consider signing up for the AFLAC Cancer policy.

Rec-Fitness Center membership

For you, your spouse, and your children under 19 not in college (or if single, then a friend) can be included on your membership. No need to fill out a form during open enrollment unless you are becoming a new member or changing dependents. If you wish to cancel membership, please send an email to

Medical expense reimbursement account (Section 125)

Decide how much you wish to take out of your check tax-free for medical expenses you incur during the college year that are not covered by insurance. Employees are no longer able to use Section 125 funds for over-the-counter medications, except for Insulin and OTC medications and nutritional supplements that are prescribed by a medical practitioner. There is a limit of $2500 for medical expense reimbursement. For more information, see IRS Publication 502. Also, in choosing how much to place in your medical reimbursement account, you may want to consider the deductible of $1500/3000 and the 70% coverage after meeting the deductible.

Childcare expense reimbursement account (Section 125)

Same as above, except it applies to childcare expenses for children under age 13 so you can work.

Both of the “Section 125″ reimbursement account benefits have the tax-free deduction advantage mentioned above, but both contain a penalty–what you haven’t used for eligible expenses occurring during the college year is forfeited. In completing this section, remember to enter both the per pay amount and multiply it times 24 to enter the total year’s contribution. Everence, the company that processes our reimbursement accounts, will send you a confirmation letter early in the college year. Please review it carefully for accuracy.

NOTE: For those participating in either medical or childcare reimbursement accounts, you will need to file claim forms with Everence along with the explanation of benefit forms you receive from Highmark PPO or the receipt from your childcare provider. Claim forms are found here.

Sign-up instructions — Please download the Section 125 Annual Enrollment form [PDF fill-in form], complete, print, sign and send to the Human Resources office via campus mail. We suggest you make a copy of the form. If you would like a form sent to you via campus mail instead, contact, or call x6111. We strongly encourage you to complete one at the Benefits Fair on April 16th. On this form you need to list your health, dental and supplemental insurance coverage choices, and the amount to be placed in your medical or childcare reimbursement account. Please consult the AFLAC representative (Cheryl Miller, 875-1961) to enroll and determine your premium amount.

Please complete one even if you are not having any money withheld from your paycheck (you would sign at the bottom of the form that you are declining to participate). Employees who are working .5 to .749 FTE are eligible for health insurance coverage, but pay a pro-rated amount for single and dependent coverage. Please contact HR to determine the amount you will pay.

You need to complete a new application for health, dental, AFLAC and Vision Service Plan insurance only if you are adding or changing dependent coverage.

If you do not send us a Section 125 enrollment form for 2014-15, we will continue the same coverage you elected in 2013-14 on medical, dental, and supplemental insurances. We will also assume you do NOT want to participate in the medical or childcare reimbursement accounts in 2014-15.

If you are enrolling in dental, health or any supplemental insurance for the first time or changing coverage, you must complete new enrollment forms. Completing the Section 125 form alone will not change your coverage. The health insurance form is available at Dental and the other insurance applications will be available at the Benefits Fair or from the HR office.

Return all forms to Vickie Miller through campus mail or drop them off at Westlawn 103 no later than Friday, May 30th. Call Vickie Miller or Norm Bakhit with any questions.


TIAA-CREF and Everence Financial representatives will be available at the Benefits Fair or you may contact them directly anytime about enrolling. Changing the amount withheld from your paycheck for your retirement fund can be done anytime during the year so is not part of the open window/enrollment period. Please request a salary reduction agreement from the HR office.

As always, contact Vickie Miller at, 535-6111, or Norm Bakhit,, 535-7507, for more information.