Open Enrollment Period: November 1-December 5, 2012
Detailed information summarizing new (and all other) benefit programs are included in the Open Enrollment letter (pdf). 

All enrollment forms with changes must be received in the human resources office by the December 5, 2012, deadline. Any changes you make will be effective January 1, 2013, as will any applicable changes to your 2013 payroll deductions.

The Benefits Fair on Thursday, November 8 from 10 a.m.-2 p.m. in the Red Barn is a great opportunity to meet with representatives from the benefit plans and other on-campus groups and have your questions answered by the experts.

Nancy Booth will be available in FPH Faculty/Staff Lounge on the following dates to provide a benefit overview and assist you with any questions you may have:

• Monday, November 12 from 11 a.m.-2 p.m.
• Wednesday, November 28 from 1:30 p.m.-3:00 p.m.

The annual benefits open enrollment period is the one occasion each year during which employees have the opportunity to make voluntary changes to their enrollment elections for their health, dental, and vision insurances as well as to their election to participate in the medical and/or dependent care Flexible Spending Accounts (FSA).

Benefit Enrollment/Change/Reimbursement Forms and Additional Information

Health Insurance

Health Insurance Enrollment/Change Form (pdf) Find your insurance plan on the list below. Write the corresponding letter on the PRODUCT line next to the Member Section arrow (in blue) on the enrollment/change form. 

• HMO = B
• Advantage (Low Cost) HMO = E
• PPO = L

Advantage (Low Cost) HMO Information

Advantage (Low Cost) HMO Summary of Benefits (pdf)
Low Cost HMO Deductible Details Information Sheet (pdf) REVIEW CLOSELY
Low Cost HMO Member Information Sheet (pdf)

Other Health Information and Reimbursement Forms

HMO Summary of Benefits (pdf)
PPO Summary of Benefits (pdf)
Fitness Reimbursement Form 2012 (pdf)
Prescription Mail Order Form (pdf)
Member Reimbursement Medical Claim Form (pdf)

Dental Insurance

Dental Insurance Enrollment/Change Form (pdf)
Dental Claim Form (pdf)

Vision Insurance

Vision Insurance Enrollment/Change Form (pdf)
Out-of-Network Claim Form (pdf)

Flexible Spending Account
The IRS has decreased the amount that you can elect for the health care spending account from $5,000 to $2,500 effective January 1, 2013. The dependent care maximum remains at $5,000 for 2013.

Flexible Spending Account Enrollment Form 2013 (pdf)
Health Care Flexible Spending Account Calculator (pdf)
Dependent Care Flexible Spending Account Calculator (pdf)
Flexible Spending Claim Form (pdf)

Life Insurance

Effective January 1, 2012, Hampshire changed from the current age-banded basic life insurance benefit to a flat 2.0 times annual salary benefit, up to a maximum of $150,000 (the same maximum as under our current benefit). The new 2.0 times salary benefit will provide a more equitable benefit for all benefits-eligible employees. 

In addition, in response to requests from some employees, Hampshire added a new employee paid supplemental life benefit option. Employees will also have the option to purchase life insurance for their spouses or partners and/or children.

Life Insurance Enrollment Form (pdf)
Beneficiary Change Form (pdf)
Life Insurance FAQs (pdf)
Supplemental Life Insurance Summary of Benefits (Payroll-Monthly) (pdf)
Supplemental Life Insurance Summary of Benefits (Payroll-Biweekly) (pdf)
 

This website is intended as a general overview of Hampshire College benefits plans only. Every effort has been made to summarize these programs accurately. In all cases, the actual provisions of each benefit plan will govern if there is any inconsistency between this site and Hampshire’s formal plans or contracts.