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Health Insurance

Are you currently enrolled in health insurance and want to change plans effective 7-1-2014 (i.e. Blue to Orange, or Orange to Blue)?

Complete the BCBSM Change Form and indicate new plan selection (i.e. Orange or Blue) and return to HR.

If you are enrolling in the ORANGE HDHP w/Health Savings Account, please, also complete Employee HSA Contribution Form and return to HR. (NOT required for BLUE Plan selection).

Are you currently not participating in Hope's health insurance plan and want to enroll for coverage effective July 1, 2014?

To enroll in health insurance, please complete the BCBSM Enrollment Form. Prior to completing the form, you will want to review and select your health insurance plan option. Selection of the plan option may only be made annually during open enrollment. All employees are responsible for contributing toward the cost of health insurance.
Are you currently enrolled in health insurance but want to terminate and waive coverage effective July 1, 2014?
To waive coverage, please complete the Health Insurance Waiver form and return to HR.
Do you wish to enroll a newly eligible dependent for coverage effective July 1, 2014? On your KnowHope Plus Benefit Summary, is the information listed for your dependents incorrect (i.e. a dependent listed is no longer eligible and/or a dependent that should be listed is not?)

On the BCBSM Change Form, complete:

  1. All of Section 1
  2. In Section 2 and 3, complete information for only the dependent with a change
  3. In Section 4, sign and date

Return to HR

If your spouse will be covered by Hope's Health Plan as of 7-1-2014, you must complete the Spouse Eligibility Requirements Form and return to HR.

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