Instructions and Overview of Classified and Exempt Enrollment Forms

You must complete and submit the following seven forms (six if not covering a spouse or qualified same-sex domestic partner) to the Human Resources (HR) Department in Bouillon Hall 140 or at mailstop 7425.

Completed health plan forms must be returned within the first 31 days of eligibility and life insurance enrollment forms within the first 60 days of eligibility. Retirement forms for administrative staff must be returned within the first 31 days of eligibility; for classified staff, a choice must be made between PERS 2 and 3 within 90 days.

If you choose to waive any coverage, indicate so on the enrollment form. Dental coverage may not be waived.

Please note:
Forms 6 and 7 are the enrollment forms 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.

Forms 8 and 9 are the enrollment forms for administrative/exempt staff eligible for 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 or email humanres@cwu.edu.

ENROLLMENT FORMS Completed forms must be returned to HR within 31 days of hire.

1. 2009 Employee Medical/Dental Enrollment/Change Form [REQUIRED]
2. Spouse or Same-Sex Domestic Partner Certification [REQUIRED if covering spouse or SSDP]
   • If covering spouse, complete page 4
   • If covering Same-Sex Domestic Partner, complete pages 4 and 5. [Pages 1 - 3 contain instructions and a worksheet to assist you in completing the forms]

Compare Plans

Plans available:

Medical
Managed care plans:	Group Health Classic or Value
	Aetna
State's preferred provider plan:	Uniform Medical

Dental
Managed care plans:	DeltaCare
	Willamette
Preferred provider plan:	Uniform Dental

ENROLLMENT FORM Completed form must be returned to HR within 60 days of hire.

3. Life Insurance Enrollment Form [REQUIRED]

CWU provides a $25,000 term life insurance policy. Additional coverage is available.

ENROLLMENT FORM Completed form must be returned to HR within 31 days of hire.

4. LTD Insurance Enrollment Form [REQUIRED]

CWU provides basic coverage after 90 days of disability for all benefits eligible employees. Additional insurance may be purchased.

5. Retirement Status Form [REQUIRED]

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.

6. Department of Retirement Systems Member Information Form [REQUIRED]
7. Retirement Plan Beneficiary Designation [REQUIRED]

Enrollment Forms: Completed forms must be returned to HR within 31 days of hire.

You must submit the CWURP Enrollment form and an enrollment form for each selected vendor.

8. CWURP Enrollment Form [REQUIRED]
9. Vendor Enrollment Forms [One or more REQUIRED]
   Fidelity (Print form; complete, sign, and return to HR)
   TIAA-CREF (Enroll online)
   Vanguard (Complete form online; print, sign, and return to HR)

Contributions to the mandatory retirement plan are matched by the university. Funds may be invested with Fidelity, TIAA-CREF, and/or Vanguard.