Instructions and Overview of Faculty 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. 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.
   
   2007 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.)
   
   
4. Long-Term Disability (LTD) Insurance: Form must be signed and returned to Human Resources within 30 days of hire.
   
   • Tenure/tenure-track/1-year/9-month contract faculty: 90-day LTD coverage is provided.
   • Non-tenure track (faculty hired on a quarter-to-quarter basis): Basic LTD coverage is provided.
   
   
5. CWU Retirement Plan (CWURP) Enrollment: 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 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. Vendor enrollment packets are available from Human Resources. Contact Eileen Stokes at (509) 963-1267 to order vendor packets and set up a meeting to discuss your retirement plan decision. If you are a non-tenure track faculty, you may waive participation in the retirement plan. If you choose to do so, please indicate so on the waiver form and return to the Human Resources Office.
   
   
6. 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.
   
   
7. Retirement Status Form: Participation in any Washington State Department of Retirement Systems (DRS) plans must be declared.