Page 41 - 2019 CommScope AE
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Your Enrollment Checklist
Between October 15 and November 2, 2018, you must enroll or you won’t have medical coverage (including
prescription drug), dental, vision, and voluntary or supplemental STD (non-exempt salaried or plant hourly
employees) coverage through CommScope for you or your family next year.
You must enroll if you want to participate in a Health Savings Account, Healthcare, and/or Dependent Care FSA in
2019.
Check the Box Once You Have Completed the Annual
Enrollment Activity
Done
I have thought about how my family used our beneits during 2018 and considered our needs for the 2019 plan year (January
1 to December 31).
I have read through this guide and used the MyChoice decision support tool at www.commscopeconnect.com to determine
which medical plan is right for me and my family.
I have participated in an Annual Enrollment meeting or reviewed the Annual Enrollment Brainshark
I have considered which coverage is needed by my family members and I have social security numbers for those I wish to
add.
If I am enrolling in either Health & Investment Plan A or B, I have considered how much I want to contribute to the HSA.
I have viewed the three Bank of America HSA webinars located on the U.S. employee beneits website .
I have reviewed the OptumRx formulary through the UHC homepage to determine how my prescriptions will be covered
in 2019.
I understand if I have an existing prescription, I may need a new one.
I have evaluated how I can use an FSA or limited use FSA to maximize my tax savings.
I have considered optional life and accidental death and dismemberment (AD&D) insurance for myself and my dependents.
I have enrolled in 2019 group beneits through the U.S. employee beneits website .
I have printed my conirmation of beneits statement from the U.S. employee beneits website and reviewed it for accuracy.
If I needed to make 2019 enrollment election changes, I went back to the U.S. employee beneits website and made
corrections before November 2.
I have enrolled in Rally.
I have completed the Transition of Care process for serious and ongoing medical treatments (if applicable).
41
Between October 15 and November 2, 2018, you must enroll or you won’t have medical coverage (including
prescription drug), dental, vision, and voluntary or supplemental STD (non-exempt salaried or plant hourly
employees) coverage through CommScope for you or your family next year.
You must enroll if you want to participate in a Health Savings Account, Healthcare, and/or Dependent Care FSA in
2019.
Check the Box Once You Have Completed the Annual
Enrollment Activity
Done
I have thought about how my family used our beneits during 2018 and considered our needs for the 2019 plan year (January
1 to December 31).
I have read through this guide and used the MyChoice decision support tool at www.commscopeconnect.com to determine
which medical plan is right for me and my family.
I have participated in an Annual Enrollment meeting or reviewed the Annual Enrollment Brainshark
I have considered which coverage is needed by my family members and I have social security numbers for those I wish to
add.
If I am enrolling in either Health & Investment Plan A or B, I have considered how much I want to contribute to the HSA.
I have viewed the three Bank of America HSA webinars located on the U.S. employee beneits website .
I have reviewed the OptumRx formulary through the UHC homepage to determine how my prescriptions will be covered
in 2019.
I understand if I have an existing prescription, I may need a new one.
I have evaluated how I can use an FSA or limited use FSA to maximize my tax savings.
I have considered optional life and accidental death and dismemberment (AD&D) insurance for myself and my dependents.
I have enrolled in 2019 group beneits through the U.S. employee beneits website .
I have printed my conirmation of beneits statement from the U.S. employee beneits website and reviewed it for accuracy.
If I needed to make 2019 enrollment election changes, I went back to the U.S. employee beneits website and made
corrections before November 2.
I have enrolled in Rally.
I have completed the Transition of Care process for serious and ongoing medical treatments (if applicable).
41
