Page 3 - 2021-2022 New Hire Benefits

Welcome to the 2021-2022 Renbrook School Benefit Enrollment. Please use the following checklist to
assist with your benefit elections:

Benefit Option Procedure Deadline
Medical Insurance o Review the available ConnectiCare medical Within 30 days of the start of
Plan insurance plans. employment, return the completed
o Complete the Medical Plan Election Form. Medical Plan Election Form
o Note: If you choose not to participate in the plan, whether or not you choose to
you will still need to decline coverage on the participate and the ConnectiCare
election form. Enrollment/Change form if you are
o If you wish to participate in the plan, complete the electing coverage.
ConnectiCare Enrollment/Change Form.
Voluntary Vision o Review the EyeMed plan information. Within 30 days of the start of
Plan o If you wish to enroll in the plan: employment, if you choose to
o Complete the Voluntary Vision Plan participate in the plan, return the
Election Form; and completed Voluntary Vision Plan
o Complete the EyeMed Enrollment Form. Election Form and the EyeMed
o Enrollment Form.
Flexible Spending o Review the Discovery Benefits flexible spending Within 30 days of the start of
Account (Medical or plan information. employment, return the completed
Dependent Care) o Complete the Discovery Benefits Health Care and Discovery Benefits Health Care and
Dependent Care Flexible Spending Accounts Dependent Care Flexible Spending
Enrollment Form. Accounts Enrollment Form.
o Note: If you choose not to participate in the plan,
you will need to decline coverage on the
enrollment form.

Health Savings o Review the health savings account information You may elect to open a health
Account o If you elect to participate in one of the School’s savings account at any time. If you
high deductible health plan options, you may open choose to open a health savings
a health savings account: account, return the Health Savings
o Complete a Health Savings Account Account Application and the Health
Application; and Savings Account Payroll Deduction
Complete a Health Savings Account Payroll Form.
Deduction form
Group Life and o Review the plan summary included for your Within 30 days of the start of
AD&D and Group information. The School provides group life employment, return the completed
Long Term Disability insurance through SunLife at no cost to you. SunLife Beneficiary Form.
Insurance o Complete the SunLife Beneficiary Form.

Renbrook School o Review the 403(b) retirement plan information and Within 30 days of the start of
Retirement Plan investment fee disclosures. employment, if you choose to
o If you wish to enroll in the plan: participate in the plan, enroll in the
o Enroll in the plan online at www.tiaa.org; and plan online and return the
o Complete the Agreement for Salary Reduction completed Agreement for Salary
Under Section 403(b). Reduction Under Section 403(b).