This Open Enrollment Notification provides crucial information to employees regarding
the use of their benefits. This form contains all the necessary information, including
dates, notification, who to contact, and a final reminder. This document can easily be
adapted to the user's unique situation. This document in its draft form contains
numerous of the standard clauses commonly used in this type of notification; however,
additional language may be added to allow for customization to ensure the specific
language of the user is addressed. Use this form to give notice to employees regarding
the use of their benefits.
Open Enrollment Notification
The _______________ [Instructions: insert year] Open Enrollment period will be a ____
[two (2)] [Comment: this timeframe is limited for tax reasons] week period that will begin
_______________ [Instructions: insert date] and run through _______________
[Instructions: insert date]. For most benefits, Open Enrollment is the only time during the
year when you can add, drop, or change a benefit. Make sure you enroll during this period.
1. Dates: Open Enrollment for all employees will be _______________ [Instructions: insert
method of enrolling - online or by paper enrollment] this year. You should study the
comparison of plan benefits to choose the plan that best meets your needs. The BCBS 903
PPO Plan is no longer available and a new lower-cost option (BCBS 03359 PPO Plan) is
being added. Because IRS regulations will not permit you to change plans mid plan year,
the plan you choose during Open Enrollment is the plan you will be required to remain in
through _______________ [Instructions: insert date].
2. Notification: This is the only hard copy Open Enrollment notification/information you will
receive. All supporting information (brochures, medical plan comparison, premium sheets,
etc.) and forms will be available _______________ [Instructions: insert location where
information is available].
3. Final Reminder:
A. For most benefits, Open Enrollment is the only time you can add, drop, or change a
benefit. You should not miss this opportunity.
B. Carefully review the information in this Open Enrollment Notification and the
information on the Insurance & Benefits website (Open Enrollment link) before
making your Open Enrollment elections.
C. Do not wait until the last minute! Complete your online enrollment as early in the
Open Enrollment period as possible.
4. Who to Contact for Help:
If you have any questions about the Open Enrollment process, please call _______________
[Instructions: insert name of person or company to contact] at _______________
[Instructions: insert number].
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