Instructions and Overview of Classified and Exempt Enrollment Forms

Please complete the following forms and return them to the Human Resources Department in Bouillon Hall. If you choose to waive any coverage, indicate so on the enrollment form. You may not waive dental coverage. Please note that forms #7 and #8 are specifically for classified staff eligible for the Department of Retirement Systems (DRS) retirement plan. If you are an administrative exempt employee, but have previously been employed in a DRS-covered position, you may have a choice regarding your retirement plan. Form #9 is specifically for administrative exempt staff enrolling in the CWU Retirement Plan (URP). If you are classified staff, but have previously been employed in a URP-covered position, you may have a choice regarding your retirement plan. Call (509) 963-1202 with questions.

1. Overview of benefit package: Form must be signed and returned to Human Resources within 30 days of hire.
   
   
2. Medical/Dental Insurance: Before completing enrollment form, review information on the Public Employees Benefits Board website. If you will be residing in Ellensburg (Kittitas County), you may choose between Group Health Classic, Group Health Value, and Uniform Medical. Form must be signed and returned to Human Resources within 30 days of hire. For more information, refer to the enrollment guide.
   
   2008 Employee Premium Rates:

   Plan	Employee Only per month (per paycheck)	Employee & Spouse per month (per paycheck)	Employee & Child per month (per paycheck)	Family per month (per paycheck)
   Group Health Classic HMO	$74 ($37)	$158 ($79)	$130 ($65)	$214 ($107)
   Group Health Value HMO	$20 ($10)	$50 ($25)	$37 ($17.50)	$65 ($32.50)
   Uniform Medical Plan PPO	$28 ($14)	$66 ($33)	$49 ($24.50)	$87 ($43.50)

3. Life Insurance: Basic Life Insurance of $25,000 and Accidental Death and Dismemberment Insurance of $5,000 is provided. Additional insurance may be purchased within 60 days of hire. (See premiums on page 5.) For more information, refer to the plan booklet.
   
   
4. Long Term Disability (LTD) Insurance: Basic LTD insurance is provided. Additional insurance may be purchased. Premium information is available on the Public Employees Benefits Board website. Form must be signed and returned (whether purchasing additional insurance or not) to Human Resources within 30 days of hire. For more information, refer to the plan booklet.
   
   
5. Spouse or Same-Sex Domestic Partner Certification: Submit with medical/dental enrollment to cover spouse or same sex domestic partner. Form must be signed and returned to Human Resources within 30 days of hire.
   
   
6. Retirement Status Form: Participation in any Washington State Department of Retirement Systems (DRS) plans must be declared.
   
   
7. Department of Retirement Systems Member Information Form (CLASSIFIED STAFF ONLY): A decision must be made between retirement plan PERS 2 or 3. Form must be signed and returned to Human Resources within 90 days of hire. For more informaton, refer to the plan choice booklet.
   
   
8. Retirement Plan Beneficiary Designation
   
   
9. CWU Retirement Plan (CWURP) Enrollment (ADMINISTRATIVE EXEMPT STAFF ONLY): Participation is mandatory. Required contribution rates are 5% (to age 35), 7.5% (age 35 - 50), and 10% (age 50+). Contributions matched by the university. Funds may be invested with Fidelity, TIAA-CREF, and/or Vanguard. Contributions begin from your hire date, but you have 30 days to complete and submit the enrollment form and vendor enrollment form.
   
   To enroll in the retirement plan, you must submit the CWURP Enrollment form and enroll with your selected vendor.
   
   • Fidelity
     Form must be printed, completed, and returned to the Human Resources Department.
   • TIAA-CREF
     You may enroll online.
   • Vanguard
     Form can be completed online and then must be printed, signed, and returned to the Human resources Department.
   
   We are available to discuss your retirement options with you. Call our office at (509) 963-1202.