Open Enrollment
Section Navigation
E-Packet
- Open Enrollment Checklist
- Open Enrollment Letter
- Open Enrollment Benefits Summary
- Summary Plan Description 2014
Individual Forms
Medical/Dental
- Premera Member Enrollment and Change Application
- Whitman Benefit Changes Open Enrollment Form
- Premera Health Premiums for 2014
- Premera Waiver of Coverage (Cash in Lieu)
FSA
- FSA Info Sheet
- FSA Brochure – Start Saving
- FSA Election Form
- FSA Electronic Deposit Form
- mySourceCard Brochure
- Frequently Asked Questions about mySourcecard
- The Benefits of mySourceCard — Educational Video
- Making the most of your Flexible Spending Account with the mySourceCard — Educational Video
- mySourcecard Enrollment Agreement
- Over-the-counter (OTC) Dr. Authorization
- 125 FSA Voucher
- FSA Qualifying & Non-Qualifying Expenses 2014
- FSA 125 Brochure Whitman