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, 2014.
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) (Dearborn National)
Retiree Benefits Letter
Retiree Rate Sheet
Retiree Benefits Enrollment Form
Affidavit of Dependent Eligibility
Group Life Insurance Application