2023 Open Enrollment - May 1 - 17, 2023
If you are NOT making changes to your benefits, no action needs to be taken UNLESS you cover a spouse on your medical plan - see spousal coordination of benefits section below.
No documents will we accepted after May 17, 2023
All documents should be returned to email@example.com or the drop box located in the lobby at 5 E. Reed St.
Memo to Active Full-time and eligible Part-time Employees and 2023 Rates (PDF)
Medical Open Enrollment (Highmark or Aetna)
Online Open Enrollment Course (link)
State Benefit Office Resource Page (link)
Summary of Benefits - Highmark BCBS - First State Basic (PDF)
Summary of Benefits - Highmark BCBS - Comp PPO (PDF)
Summary of Benefits - Aetna - HMO (PDF)
Summary of Benefits - Aetna - CDH Gold (PDF)
Federal Notices (PDF)
Spousal Coordination of Benefits - Medical Only
Employees who cover spouses on any State of Delaware medical plan is required to complete the spousal coordination of benefits each year.
Spousal Coordination of Benefit Form (link)
Dental Open Enrollment (Delta Dental)
Summary of Benefits - Delta Dental (PDF)
Vision Open Enrollment (Vision Benefits of America)
Summary of Benefits - Vision Benefits of American (PDF)
Supplemental Life Insurance (UNUM and/or TransAmerica)
Summary of Benefits - TransAmerica (PDF)
Summary of Benefits - UMUM (PDF)
457 Changes - DOE and IBEW Employees ONLY
Per the DOE* & IBEW** Union contracts:
“Each May, during open enrollment, employees will have the opportunity to change their contribution to the 457 plan thus effecting the City’s matching contributions to the 401 Money Purchase Plan. The change will be effective July 1 and irrevocable until the following July.”
If you are interested in changing your contribution to the 457 plan, or if you have any questions, please contact Human Resources for the appropriate forms to complete.
*DOE Union Contract July 1,2020- June 30, 2024, Section 25. 401 Retirement Contribution
** IBEW Union Contract July 1, 2020 - June 30, 2023; Section 42. 401a Money Purchase Plan
Forms to complete of changes: (documents are to be returned to firstname.lastname@example.org or the drop box located in the lobby or 5 E. Reed St.
If you would like to make changes to your benefits please complete the required forms below.
If adding a spouse a copy of the marriage certificate and social security card is required
If adding a child/dependent a copy of the birth certificate and social security card is required
Highmark Enrollment/Disenrollment Form (PDF)
Aetna Enrollment/Disenrollment Form (PDF)
Delta Dental Enrollment/Disenrollment Form (PDF)
Vision Benefits of American Enrollment/Disenrollment Form (PDF)
TransAemerica Life Insurance Enrollment/Disenrollment Form (PDF)
UNUM Life Insurance Form Enrollment/Disenrollment (PDF)
Mission Square 457 Enrollment/Changes Form (PDF)
2023 HOLIDAY SCHEDULES BY UNION
2023 AFSCME, DOE, NB Holiday Schedule
BENEFICIARY UPDATE: Click on the appropriate form, print, complete and return to Human Resources.