This page shows a summary of the changes you are about to make.
Please verify your changes carefully before submitting.
If you need to make any edits you can do so by selecting the plan type or plan description hyperlink to return to the election page.
When you are satisfied with your changes, please click the Submit button on the toolbar.
By clicking Submit you are acknowledging the following:
Clicking Submit serves as my electronic signature.
I have been notified that all required benefit plan documents are available electronically from the Ultipro Home Page.
I understand that the benefit choices made during open enrollment will be in effect for the current plan year.
I am authorizing my employer to deduct from my bi-weekly paycheck the amount necessary to pay for any pre-tax benefit elections made using this online enrollment system.
I further authorize future adjustments in the amount of the salary reduction in the event that the cost of coverage in any program selected is changed during the plan year.
If I decline a benefit, I cannot change my election to enroll in a pre-tax benefit plan unless I experience a qualifying life event.
This authorization will continue in effect unless I change my election during the annual open enrollment period, or I experience a qualifying life event.
I understand that I am responsible for initiating any change in my elections due to a qualifying life event,
as described under the "Plan", with in 31 days of such event by notifying my HR representative in writing.