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Forms2013 Benefits Open Enrollment Form (pdf) - One form to enroll in the core benefits programs offered to employees working 20+ hours a week. 2013 Joint Program Student - Benefits Open Enrollment Form (pdf) 2013 Postdoctoral Scholar/Fellow - Benefits Enrollment Form (pdf) 2013 Healthcare Flexible Spending Account (HC-FSA) Enrollment Form (pdf) - form required by Benefit Strategies (third-party FSA administrator) to enroll in the Healthcare FSA. Domestic Partner Affidavit (pdf) - Required to add your Domestic Partner to coverage. Domestic Partner Form (pdf) - Required to discontinue your Domestic Partner's coverage. 2013 HIRD Form (pdf) - Health Insurance Responsibility Disclosure (HIRD) form is required from every employee who declines to enroll in WHOI's medical plan or the "Premium Only" Section 125 Plan. A new form is required every year if waiving medical coverage. 403(b) Defined Contribution Retirement Plan (DC Plan) - Beneficiary Designation Form Defined Benefit Retirement Plan (DB Plan) - Beneficiary Form Direct Deposit Form - Benefit Strategies (for Healthcare FSA) ToolsDependent Care Flexible Spending Account (DC-FSA) Worksheet - useful tool to help you determine your annual Dependent Care FSA contribution. When establishing a DC-FSA, employees should also consider any Dependent Care Subsidy benefits they may be eligible for. IRS Publication 502- Medical & Dental Expenses for use in preparing your tax returns. IRS Publication 503 - Child & Dependent Care Expenses for use in preparing your tax returns. Employee Online - Provides the ability to review and make certain changes to personnel records including changes to medical and dental benefits. Should you need a password please complete the online request form. Massachusetts Health Care Reform - Human Resources website explaining the Massachusetts Health Care Reform Act. Blue Cross Blue Shield of Massachusetts - link to the official BCBS of Massachusetts website. Blue Cross Blue Shield - PPO Provider Directory - to find a doctor or hospital in the PPO National Network (useful for out-of-New England members). Delta Dental of Massachusetts - link to the official Delta Dental website. Flexible Spending Account (FSA) Informational Sheet - explains the benefits of pre-tax savings with Flexible Spending Accounts and how the reimbursement process works. Healthcare Flexible Spending Account (HC-FSA) Worksheet (pdf) - useful tool to help you determine your annual Healthcare FSA contribution. Last updated: October 1, 2012 | |||||||||||||
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