Open Enrollment: November 15, 2021 – December 15, 2021

Election Changes will be Effective January 1, 2022

• ENROLLMENT DEADLINE: You MUST enroll no later than 4:30 pm AKST on December 15, 2021
  All legal documents and other required documents must be turned in to Stacey Cockroft (Vinson) at the District Office by the deadline of 4:30 pm AKST on December 15, 2021
• CURRENT ENROLLEES — IF YOU HAVE NO CHANGES: No action is required from you; your current enrollment will remain the same
• Enrollment forms are available online
• ALL changes made during Open Enrollment will be effective January 1, 2022.

If you are enrolling a new dependent, you must provide legal documentation as follows:

• Spouse:
  Marriage Certificate (photocopy)
• Children:
  A photocopy of the child’s birth certificate, naming you or your spouse as the child’s parent; or appropriate court order/adoption decree naming you or your spouse as the child’s legal guardian.

If you are electing the HRA Plan:

1. Complete enrollment form with all changes marking “OPEN ENROLLMENT” & “HRA PLAN”
2. You don’t need to list currently enrolled dependents that you wish to remain enrolled, however, if you would like to drop a dependent child, mark “DROP” next to their name. If you are dropping your spouse, you must also include the Request to Remove Spouse Form that must be notarized. List any new dependents and check “ADD” next to their name, be sure you include the required legal documents.
3. Submit all documents to Stacey Cockroft (Vinson) by the Open Enrollment deadline.

If you are electing the HSA Plan:

1. Fill out the paper enrollment form in the Open Enrollment Guide marking “OPEN ENROLLMENT” & “HSA PLAN”
2. You don’t need to list currently enrolled dependents that you wish to remain enrolled, however, if you would like to drop a dependent child, mark “DROP” next to their name. If you are dropping your spouse, you must also include the Request to Remove Spouse Form that must be notarized. List any new dependents and check “ADD” next to their name, be sure you include the required legal documents.
3. Carefully read the HSA FAQ and eligibility guidelines to ensure you are eligible. If you are unsure of your HSA eligibility, we recommend that you consult a tax, legal or financial advisor to discuss your personal circumstances that may affect your HSA eligibility. KPBSD cannot consult you about your HSA eligibility.
4. Fill out the HSA Enrollment Form and return all pages
5. Rehn requires you to list a physical address on the form even if you don’t receive mail at that address. If you have a PO Box you may also list this on the form so Rehn can note that in their system.
6. Submit all documents to Stacey Cockroft (Vinson) by the Open Enrollment deadline.

Remember, this is your opportunity to make changes to your elections for the 2022 Plan Year. The deadline for submitting your enrollment form is 4:30 PM on December 15, 2021. After that date, you cannot change your elections until the next Open Enrollment period in Nov/Dec 2022, unless you experience a Special Enrollment (Qualifying) event as described in the Summary Plan Description.

Please submit your enrollment forms by the Open Enrollment deadline to:
Stacey Cockroft (Vinson)
Employee Benefits Manager
Kenai Peninsula Borough School District
148 N. Binkley St. Soldotna, AK 99669
Phone: 907.714.8879 | Fax: 907.262.9645
SVinson@kpbsd.k12.ak.us

Available online: The Open Enrollment packet and medical option descriptions