1. Open Enrollment will be held from November 9th through November 23rd

2. All employee’s must complete the Benefit Election form regardless if enrolling or declining coverage.

3. It’s important to provide your work or home email address. This will allow us to send insurance certificates.

4. ENROLLMENT FORMS NEED TO BE COMPLETED as follows:

1.    Section A, B & C: On Page 8 of the Benefit Alert

• Complete Employee and Dependent information if newly enrolling OR changing information from last year. Please complete your email address
•  Check the box for Medical Enrollment choices: Anthem, The American Worker, or Decline to enroll. 

                                              i.    Anthem - 3 plan options: Core, Buy-up , Bronze (Minimum Value)

                                             ii.    The American Worker: 1 plan – MEC Basic for preventive coverage

                                            iii.    Decline coverage

2.    Section D, E & F: On Page 9 of the Benefit Alert 

• Complete Employee information if newly enrolling OR changing information from last year.
• Dental/Vision Plan Enrollment choices - Dental and Vision are separate elections.

                                              i.    Dental Plan: Base or Buy-up (single or family coverage)

                                             ii.    Vision Plan: (single or family coverage)

                                            iii.    Decline coverage

• Voluntary Life, Accidental Death & Dismemberment & Long-Term Disability

                                              i.    Election is based on your age (see page 9 F for age brackets)

                                             ii.    Decline coverage

3.    Section G, H & I: On Page 10 of the Benefit Alert 

• Sign, print your name & date to confirm and attest to your election
• Beneficiary Designation: Always remember to update beneficiaries 
• Non-Tobacco User Affidavit. Applies to you, spouse and dependents over age 18

4.    Section J: On Page 11 of the Benefit Alert

• Spousal Surcharge Attestation. Check applicable box, sign, print name and date.

5.    Section K: On page 12 of the Benefit Alert

• Spouses Employer Statement of Coverage. Requires you, spouse and spouses Employer to complete, sign and date.  

FAX OR EMAIL REQUIRED ENROLLMENT PAPERWORK TO:

 Jennifer Wallace NO LATER THAN Nov. 23rd

Fax Number: (239) 649-6735

Email: jwallace@clevelandconstruction.com

ENROLLMENT or BENEFIT QUESTIONS? 

Call Jennifer Wallace at Cleveland Construction at 239-643-8000 or

Amanda Vasil from NFP Corporate Services (OH) Inc.

Toll Free: (855) 277-2707 or Ohio local (216) 264-2713