Important Note: The Human Resources/Civil Service will require all employees adding dependents during Open Enrollment to provide valid proof of eligibility by November 21, 2013.
Become Smoke Free!
Sign-up for the free MHN Tobacco Cessation Coaching program today! The program can be completed by telephone in seven sessions over a six week period. All employees and their family members are eligible for this free service, offered by the EAP Plan. Give them a call at (888) 779-2225.
Click here for program information
Important forms you may need…
Certification of Other Comparable Coverage Opt-Out of Medical Coverage Form
Group Optional Life Insurance Application (Dearborn National)
Evidence of Insurability (EOI) (Darborn National)
2013 Non-Tobacco User Affidavit Form
Retiree Benefits Enrollment Form
Affidavit of Dependent Eligibility
Group Life Insurance Application