10-07-2025, 03:53 AM
SITUATION: Open Enrollment, Cancellation of Automatic Cash Option Reenrollment
Employee: Jack A. Gordon
Spouse/Domestic Partner: Jill A. Gordon
Current status
Employee is currently enrolled in FlexElect for the Cash Option in lieu of medical insurance and dental insurance. Employee is enrolled on spouse's/domestic partner's health and dental plan. Spouse/Domestic Partner works for private industry.
Desired flexelect elections
Employee wants to cancel automatic Cash Option fax lists reenrollment for the next FlexElect plan year and enroll into State-sponsored medical and dental plans.
Action required
Employee must complete a STD. C to cancel his automatic Cash Option reenrollment for the next FlexElect plan year. In addition, the employee must also complete an HBD- and STD. to enroll into State-sponsored health and dental plans.
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Examples: - Open Enrollment/Change of Automatic Cash Option Reenrollment
SITUATION: Open Enrollment, Change of Automatic Cash Option Reenrollment
Employee: Jill A. Gordon
Spouse/Domestic Partner: Jack A. Gordon
Current status
Employee is currently enrolled in FlexElect for the Cash Option in lieu of both medical insurance and dental insurance. Employee has been receiving FlexElect Cash in lieu of dental insurance for three years. Spouse/Domestic Partner works for private industry.
Desired flexelect elections
Employee wishes to maintain FlexElect Cash in lieu of health insurance, cancel FlexElect Cash in lieu of dental insurance, and enroll in a State-sponsored dental plan.
FORMS REQUIRED
Employee - STD. C, STD.
Action required
Employee must complete a STD. C to change her automatic Cash Option reenrollment for the next FlexElect Plan Year. In addition, the employee must also complete a STD. to enroll in a State-sponsored dental plan.
Examples: - Open Enrollment/Medical Reimbursement Account and Automatic Cash Option Enrollment
SITUATION: Open Enrollment - Automatic Cash Option and Reenrolling in the Medical Reimbursement Account
Employee: Jack A. Gordon
Spouse/Domestic Partner: None
Current status
Employee is currently enrolled in a Medical Reimbursement Account (MRA) and the Cash Option.
DESIRED FLEXELECT ELECTIONS
Employee wants to continue the Cash Option and wants to reenroll in the MRA with a monthly deduction of .
Action required
Employee must complete a STD. R to reenroll into a MRA for the next FlexElect Plan Year. Because the employee's Cash Option enrollment will automatically continue for the next plan year, he is not required to complete a STD. C.
Employee: Jack A. Gordon
Spouse/Domestic Partner: Jill A. Gordon
Current status
Employee is currently enrolled in FlexElect for the Cash Option in lieu of medical insurance and dental insurance. Employee is enrolled on spouse's/domestic partner's health and dental plan. Spouse/Domestic Partner works for private industry.
Desired flexelect elections
Employee wants to cancel automatic Cash Option fax lists reenrollment for the next FlexElect plan year and enroll into State-sponsored medical and dental plans.
Action required
Employee must complete a STD. C to cancel his automatic Cash Option reenrollment for the next FlexElect plan year. In addition, the employee must also complete an HBD- and STD. to enroll into State-sponsored health and dental plans.
Examples: - Open Enrollment/Change of Automatic Cash Option Reenrollment
SITUATION: Open Enrollment, Change of Automatic Cash Option Reenrollment
Employee: Jill A. Gordon
Spouse/Domestic Partner: Jack A. Gordon
Current status
Employee is currently enrolled in FlexElect for the Cash Option in lieu of both medical insurance and dental insurance. Employee has been receiving FlexElect Cash in lieu of dental insurance for three years. Spouse/Domestic Partner works for private industry.
Desired flexelect elections
Employee wishes to maintain FlexElect Cash in lieu of health insurance, cancel FlexElect Cash in lieu of dental insurance, and enroll in a State-sponsored dental plan.
FORMS REQUIRED
Employee - STD. C, STD.
Action required
Employee must complete a STD. C to change her automatic Cash Option reenrollment for the next FlexElect Plan Year. In addition, the employee must also complete a STD. to enroll in a State-sponsored dental plan.
Examples: - Open Enrollment/Medical Reimbursement Account and Automatic Cash Option Enrollment
SITUATION: Open Enrollment - Automatic Cash Option and Reenrolling in the Medical Reimbursement Account
Employee: Jack A. Gordon
Spouse/Domestic Partner: None
Current status
Employee is currently enrolled in a Medical Reimbursement Account (MRA) and the Cash Option.
DESIRED FLEXELECT ELECTIONS
Employee wants to continue the Cash Option and wants to reenroll in the MRA with a monthly deduction of .
Action required
Employee must complete a STD. R to reenroll into a MRA for the next FlexElect Plan Year. Because the employee's Cash Option enrollment will automatically continue for the next plan year, he is not required to complete a STD. C.
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