FY24 OPEN ENROLLMENT (May 1 - 31, 2023)

Enrollment Forms

  1. Insurance Enrollment-Declination Form
  2. Flexible Spending Account (FSA) Enrollment Form

Health Plan Designs

  1. Medical
  2. Dental
  3. Vision

Flexible Spending Account (FSA)

  1. The BESTFlex Plan
  2. Health Care FSA Eligible Expenses
  3. Dependent Care FSA Eligible Expenses

Annual Notices

  1. NOTICE - 4 in 1 Annual Health Plan Notices
  2. NOTICE - MHPAEA Exemption Notice
  3. NOTICE - Medicare Part D Creditable Coverage Disclosure
  4. NOTICE - Marketplace Coverage Options
  5. NOTICE - CHIP Notice - Iowa

Beneficiary Designation Form

  1. MNL Change of Beneficiary Form
  2. IPERS Beneficiary Designation Form