Step 1. Review Benefits Information

• Benefits Summary
• NUFlex Benefits for Newly Eligible Employees Booklet
• Summary of Benefits and Coverage (SBC)
• 
  

  Low Option	Basic Option	High Option
  Low-Regular	Basic-Regular	High-Regular
  Low-Enhanced	Basic-Enhanced	High-Enhanced

Step 2. Review Premium/Price Tag Information

• Premium/Price Tag Summary

Step 3. Complete Enrollment Form

• Benefits Enrollment Form (Required)

Step 4. Complete Dependent Information Request Form

• Dependent Information Request Form (Required IF covering dependents)
• Provide appropriate documentation to verify dependent eligibility (Dependent Verification Documentation Requirements)

Step 5. Complete Record of Prior Service (To determine eligibility for retirement plan)

• Record of Prior Service Form (Required)

Step 6. Complete Assurity Life Insurance Statement of Health Form

• Assurity Life Insurance Statement of Health Form (Required if applying for $75,000 or more of voluntary employee coverage or $20,000 or more of spouse coverage)

Step 7. Complete Health Risk Assessment

• Health Risk Assessment (Recommended)

Step 8. Review Caremark Prescription Drug Summary

• Caremark Prescription Drug Summary

Step 9. Print Prescription Drug Card (If enrolled in the medical plan)

• CVS Caremark Identification Card

Step 10. Review Long Term Care Coverage

• Long Term Care coverage is also available and requires a separate form for enrollment.
• Long Term Care Program Booklet and Enrollment Form

Step 11. Final Step – Submission of Forms

• Campus Benefits Office must receive your completed forms and dependent verification documentation within 31 days of your hire date.
• Mailing Instructions

Notice of Privacy Practices of Certain Group Health Plans
Campus Benefit Office Contact Information
Medical Policy Booklet
Dental Policy Booklet
Long Term Disability Policy Booklet

Contact your Campus Benefits Office for enrollment materials and information regarding the university’s retirement plans.