Open Enrollment 2023 MEDICA 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, 2023.
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.
HSA Employee Contribution Election Form – This form must be completed if you would like to enroll or make changes to your HSA account through a payroll deduction.
2023 Medica Insurance Election Form– This form must be completed only if changes are needed for change of coverage Single/Family and VEBA or HSA Election.
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 2023.
Keep the following in mind:
- Your entire election amount is available to you at the start of the plan year, even if you haven’t contributed funds from your paycheck yet. This means that if you have medical expenses early on, you can use your funds in advance to pay for them.
- Any unused funds over $550 in your account at the end of the plan year will be forfeited.
- You cannot change your election amount throughout the year, unless there has been a qualifying life event.
Please review the attached forms and submit any changes to Denise Nichols by November 11, 2022.
HSA Employee Contribution Election Form – This form must be completed if you would like to enroll or make changes to your HSA account through a payroll deduction.
