How to Enroll in a Medical Plan
Indicate (1) the Plan and coverage level you desire and (2) dependent information (if applicable);
Sign and date the form and submit it to your Departmental Administrator; and
Have your Departmental Administrator complete, sign and date the "Department Information" section of the form.
2. If you are enrolling dependents, you must also provide the appropriate evidence of the relationship:
|Spouse||Copy of legal marriage certificate|
|Same-Sex Domestic Partner|
Two of any of the following:
One of the following:
Dependent Social Security Numbers
Medical Plan Options
2. See the enrollment form for premiums you would have to pay under each plan.