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Open Enrollment

Information for Students is now available.

Information for Adjuncts and Casuals is now available.

Open Enrollment Period: November 2, 2015-December 4, 2015

Detailed information summarizing benefit plan changes, and other helpful Open Enrollment items are included in the Open Enrollment letter (pdf)

All enrollment forms with changes must be received in the human resources office by the Friday, December 4, 2015 deadline. Any changes you make will be effective January 1, 2016, as will any applicable changes to your 2016 payroll deductions.

The Benefits Fair 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.

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).

Donna Turban, payroll and benefits manager, will be on campus to assist you with Open Enrollment. If you have questions, need assistance with completing forms, or need to submit your forms, feel free to stop by and see her. She will be on campus on the following dates, times, and locations:

Tuesday, November 17, 2015, 3:30-4:30 p.m. FPH 101

Wednesday, November 18, 2015, 2-4 p.m. FPH Lounge

Monday, November 30, 2015, 11 a.m.-3 p.m. FPH Lounge

Thursday, December 3, 2015, 9 a.m.-2 p.m. FPH Lounge

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 = M

Advantage (Low Cost) HMO Information

2016 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

2016 HMO Summary of Benefits (pdf)
2016 PPO Summary of Benefits (pdf)
Fitness Reimbursement Form (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)

Flexible Spending Account

The IRS has set the maximum limit that you can elect for the health care spending account at $2,550 for 2016. The dependent care maximum remains at $5,000 for 2016.

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

Life Insurance

Our life insurance carrier is Symetra. The current basic life insurance benefit will remain at 2.0 times your annual salary benefit, up to a maximum of $150,000. Employees have the option to purchase additional life insurance for themselves, their spouses or partners, and children. This supplemental life insurance coverage is employee-paid.

Life Insurance Enrollment Form (pdf)
Beneficiary Change Form (pdf)
Life Insurance Evidence of Insurability Form (pdf)
Life Insurance Summary of Benefits (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.

Related Documents

Open Enrollment Additional Information Packet

Required Annual Notices



Stay In Touch
With The Benefits Office
Snail Mail
Benefits Office
Hampshire College
893 West Street
Amherst, MA 01002
Phone + Email
Fax: 413.559.5695