Open Enrollment

E-Packet

• Open Enrollment Checklist
• Open Enrollment Letter
• Open Enrollment Benefits Summary

Individual Forms

Medical/Dental

1. Premera Blue Cross Medical/Dental Enrollment Form
2. Whitman Benefit Changes Open Enrollment Form
3. Benefits Summary 2013
4. Open Enrollment Letter
5. Premera Health Premiums for 2013
6. Premera Waiver of coverage

FSA

1. FSA Info Sheet
2. FSA Brochure – Start Saving
3. FSA Election Form
4. FSA Electronic Deposit Form
5. mySourceCard Brochure
6. Frequently Asked Questions about mySourcecard
7. The Benefits of mySourceCard — Educational Video
8. Making the most of your Flexible Spending Account with the mySourceCard — Educational Video
9. mySourcecard Enrollment Agreement
10. Over-the-counter (OTC) Dr. Authorization
11. 125 FSA Voucher
12. Flex Expenses
13. FSA 125 Brochure Whitman