2021 BCBS Insurance – HSA and Flex Spending Contribution Forms

Open Enrollment is now open for anyone who would like to make changes to their insurance coverage effective January 1, 2021.

If you do not plan to make any changes to your health insurance you do not need to complete any forms for health insurance. 

Changes will not be made to the plan unless an employee completes the attached forms and indicates a change in enrollment.  The HSA Election form must be completed if enrolling or already enrolled in an HSA-Health Savings Account and you would like to make changes to contributions to your HSA plan.

  • Employer Contribution Options:
    • 100% VEBA
    • 100% HSA
    • 50% VEBA/50% HSA

Unless a new designation is made all employer contributions will continue to be made to your current VEBA or HSA plan. 

FLEXIBLE SPENDING ACCOUNT – Completed the attached form and you would like to contribute to a FLEX account for Medical or Dependent Care in 2021. 

Please review the attached forms and submit any changes to Denise Nichols by November 13, 2020.