You must complete and submit the following six forms (seven if covering a registered domestic partner) to the Human Resources (HR) Department in Bouillon Hall 140 or at mailstop 7425.
Completed health plan and retirement enrollment forms must be returned within the first 31 days of eligibility and life insurance enrollment forms within the first 60 days of eligibility.
If you choose to waive any coverage, indicate so on the enrollment form. Dental coverage may not be waived.
Call (509)-963-1202 with questions or email email@example.com.
Medical / Dental Insurance
ENROLLMENT FORMS Completed forms must be returned to HR within 31 days of hire.
1. Employee Medical/Dental Enrollment Form [REQUIRED]
Insuring Family Members: If covering family members, dependent verification documentation are required and must be submitted with enrollment form: www.pebb.hca.wa.gov/dependent.html.
Surcharges: A $25 surcharge is added to monthly premiums if you or a family member uses tobacco and a $50 surcharge is added to monthly premiums if a spouse/partner is enrolled on coverage and has chosen to not enroll in comparable medical coverage through his/her own employer. If the surcharges do not apply, an attestation form is required and must be submitted with enrollment form: www.hca.wa.gov/pebb/Documents/50-224.pdf
Wellness Incentive: The wellness program, SmartHealth, is offering a $125 wellness incentive in 2015 to eligible subscribers who complete three requirements within 60 days of eligibility: 1) Choose a primary care provider, 2) Complete your medical plan’s online health assessment (available once you’re enrolled in coverage), and 3) Start a SmartHealth Wellness Program activity: www.hca.wa.gov/pebb/documents/50-254.pdf. An attestation form indicating completion of requirements must be submitted within 60 days of eligibility: www.hca.wa.gov/pebb/Documents/50-225.pdf
|Managed care plans:|
|State's preferred provider plan:|
|Managed care plans:||DeltaCare|
|Preferred provider plan:|
ENROLLMENT FORM Completed form must be returned to HR within 60 days of hire.
2. Life Insurance Enrollment Form [REQUIRED]
CWU provides a $25,000 term life insurance policy. Additional coverage is available.
|Brief Overview||Detailed Plan Booklet|
Long Term Disability (LTD) Insurance
ENROLLMENT FORM Completed form must be returned to HR within 31 days of hire
CWU provides basic coverage after 90 days of disability for all benefits eligible employees. Additional coverage replacing 60% of salary may be purchased.
3. LTD Insurance Enrollment Form [REQUIRED]
4. Retirement Status Form [REQUIRED]
Department of Retirement Systems (DRS)
ENROLLMENT FORMS: Completed forms must be returned to HR within 90 days of hire.
A decision must be made between retirement plan PERS 2 and PERS 3. You must submit the DRS Member Information Form and the Retirement Plan Beneficiary Designation.
5. Department of Retirement Systems Member Information Form [REQUIRED]
6. Retirement Plan Beneficiary Designation [REQUIRED]
Administrative Exempt Staff
CWU Retirement Plan (CWURP) or Department of Retirement Systems (DRS) Plan 3
ENROLLMENT FORMS: An election form must be submitted and enrollment completed within 30 days of hire/date of eligibility.
A decision must be made between the Central Washington University Retirement Plan (CWURP) and the Washington State Department of Retirement Systems Public Employees' Retirement System (PERS 3).
7. CWU Retirement Plan Election [REQUIRED]
Central Washington University Retirement Plan (CWURP)
The CWURP is a defined contribution plan with required contribution rates based on age, immediate vesting, 100% matching contribution by the university, and a variety of investment options.
You must set up your account online:
8. CWURP Online Enrollment (Plan ID: 58941)
Employees who have retired from the CWURP or who have retired or are eligible to retire from a position covered by the Washington State Retirement System are ineligible to participate in the CWURP.
Public Employees' Retirement System Plan 3 (PERS 3)
The PERS 3 plan consists of a defined contribution component contributed to by the employee and a defined benefit component contributed to by the university.
9. Higher Education Plan 3 Investment Program Form [REQUIRED]
|DRS Website||Plan Overview|
|Plan Handbook||Investment Choices|