Open Enrollment

 

 

 

SCROLL TO YOUR DISTRICT AND CLICK ON THE LINKS TO VIEW OR PRINT FORMS
 
 
The open enrollment period ends on June 5, 2020.  No forms will be accepted
after this date.  Please plan extra time for mail delivery.
 
 
If you would like to make changes or begin medical or dental insurance,
complete the enrollment form.
If you are not making any changes to your medical or dental plan, you don’t
need to do anything!
If you want to start, continue or change your flexible spending or dependent
care plan, complete the enrollment form.
To complete any form, first download it to your computer, fill it out and save
it to your computer.
 
 
All completed forms must be received by Kat Richard no later than June 5th.
  • Mail your forms to the central office (30 Linden St. Exeter 03833). Allow extra time to ensure receipt by June 5th.
  • Fax to (603-775-8673)
  • Drop off in the Central Office Drop Box located at door C. 
Once you submit your forms, you can email Kat if you want confirmation
of receipt.
 
 
Please do not email your form unless you are able to encrypt the
contents as it includes sensitive personal information.
 
 
Do you have any questions?  Call member services at Health Trust
800-527-5001 with individual personal questions or submit your general
questions by email to Kat Richard at krichard@sau16.org and it will be
posted to the FAQ’s at the bottom of the Open Enrollment webpage, as
others are likely to have a similar question.

 

FAQ