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Employees & Retirees

CITY OF LINCOLN PARK INSURANCE OPEN ENROLLMENT

For Plan Year July 1, 2023, through June 30, 2024

It is now our annual open enrollment period. This is the only time during the year that you can add eligible dependents that were not previously enrolled OR if you are not presently enrolled, you may enroll in coverage with an effective date of July 1, 2023. The exception to this would be if you meet the criteria due to a qualifying event for a special enrollment.

Important information regarding open enrollment:

Each employee is REQUIRED to complete the Enrollment/Waiver of Coverage Form each Plan Year. Failure to return the Enrollment/Waiver of Coverage form by Tuesday, June 6, 2023, may result in loss of coverage and loss of the In Lieu of (ILO) payment.

If you are opting out of coverage, you MUST provide proof of group coverage. Examples of acceptable items to supply:

A letter from the employer providing group coverage that lists enrolled members
A printout from your online health insurance portal that lists enrolled members
Please contact the Human Resources Department for other acceptable documents

The deadline to return the completed form to the Human Resources Department is Tuesday, June 6, 2023. There will be no exception to this deadline.

If you would like to purchase Voluntary Life Insurance or increase the amount previously purchased, you will need to complete a medical questionnaire. For additional information regarding this enrollment process, please contact Veronica Poremba, the City’s Benefit Agent at veronica.poremba@assuredpartners.com.

If you have any questions or need additional information, please contact the Human Resources Department at (313) 386-1800, ext. 1221/1222, or Marian Trumpler of Assured Partners/Daly Merritt Insurance at 734-324-3252.

Thank you.

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Employees 19 documents

CAT:1331

2023 Blue Care Network Benefits at a Glance

document Header 2023 Blue Care Network Benefits at a Glance

file:2020

2023 Blue Care Network Rx Benefits at a Glance

document Header 2023 Blue Care Network Rx Benefits at a Glance

file:2022

2023 Blue Cross Blue Shield Benefits at a Glance

document Header 2023 Blue Cross Blue Shield Benefits at a Glance

file:2019

2023 Blue Cross Blue Shield Vision Benefits at a Glance

document Header 2023 Blue Cross Blue Shield Vision Benefits at a Glance

file:2023

2023 Delta Dental Benefits at a Glance

document Header 2023 Delta Dental Benefits at a Glance

file:2021

2023 Employee Benefit Guide

document Header 2023 Employee Benefit Guide

file:2024

2023 Employee Benefit Guide Flip Booklet

document Header 2023 Employee Benefit Guide Flip Booklet

file:2025

2023 Simply Blue HSA PPO Plan

document Header 2023 Simply Blue HSA PPO Plan

file:1933

2023 Summary of Benefits and Coverage - Blue Care Network

document Header 2023 Summary of Benefits and Coverage - Blue Care Network

file:2027

2023 Summary of Benefits and Coverage - Simply Blue HSA

document Header 2023 Summary of Benefits and Coverage - Simply Blue HSA

file:2026

2023 Summary of Benefits and Coverage - Simply Blue PPO

document Header 2023 Summary of Benefits and Coverage - Simply Blue PPO

file:2028

Employee Change Form

document Header Employee Change Form

file:1336

Enrollment/Waiver of Coverage Form

document Header Enrollment/Waiver of Coverage Form

file:1333

Families First Coronavirus Response Act (FFCRA) Employee Rights

document Header Families First Coronavirus Response Act (FFCRA) Employee Rights

file:1669

Withholding Form - Federal

document Header Withholding Form - Federal

file:1695

Withholding Form - Michigan

document Header Withholding Form - Michigan

file:1694

Flexible Spending Account 3 documents

sub:1338

Basic FSA Guide

document Header Basic FSA Guide

file:1740

Flex Eligible List

document Header Flex Eligible List

file:1739

FSA Enrollment Form 2023

document Header FSA Enrollment Form 2023

file:1889

Retirees 64 documents

CAT:1344

2023 Medicare Eligible 20 documents

sub:1724

2023 BCN Advantage Formulary

document Header 2023 BCN Advantage Formulary

file:1968

2023 MA Option 1 BAAGS

document Header 2023 MA Option 1 BAAGS

file:1970

2023 MA Option 1 Enrollment Form

document Header 2023 MA Option 1 Enrollment Form

file:1969

2023 MA Option 2 BAAGS

document Header 2023 MA Option 2 BAAGS

file:1972

2023 MA Option 2 Enrollment Form

document Header 2023 MA Option 2 Enrollment Form

file:1971

2023 MA Option 3 BAAGS

document Header 2023 MA Option 3 BAAGS

file:1974

2023 MA Option 3 Enrollment Form

document Header 2023 MA Option 3 Enrollment Form

file:1973

2023 MA Option 4 BCN BAAGS

document Header 2023 MA Option 4 BCN BAAGS

file:1976

2023 MA Option 4 Enrollment Form

document Header 2023 MA Option 4 Enrollment Form

file:1975

2023 Medicare Plus Comprehensive Formulary

document Header 2023 Medicare Plus Comprehensive Formulary

file:1965

2023 Medicare Plus Enhanced Comprehensive Formulary

document Header 2023 Medicare Plus Enhanced Comprehensive Formulary

file:1966

BCN Pre Enrollment Checklist

document Header BCN Pre Enrollment Checklist

file:1732

BCN Service Area

document Header BCN Service Area

file:1733

Benefits at a Glance BCN

document Header Benefits at a Glance BCN

file:1728

Medicare Eligible Selection Form 2023

document Header Medicare Eligible Selection Form 2023

file:1790

Medicare Eligible Selection Form ENHANCED 2023

document Header Medicare Eligible Selection Form ENHANCED 2023

file:1791

Option 1 Benefits at a Glance

document Header Option 1 Benefits at a Glance

file:1729

Option 2 Benefits at a Glance

document Header Option 2 Benefits at a Glance

file:1730

Option 3 Benefits at a Glance

document Header Option 3 Benefits at a Glance

file:1731

Option 4 Enrollment Form for BCN

document Header Option 4 Enrollment Form for BCN

file:1737

Non-Medicare Eligible 23 documents

sub:1448

Acceptance Agreement & Release Form

document Header Acceptance Agreement & Release Form

file:1824

Annual Notices 2023

document Header Annual Notices 2023

file:1839

BCBS Online Visits

document Header BCBS Online Visits

file:1666

BCN Authorization Process

document Header BCN Authorization Process

file:2032

Blue Care Network (BCN) Coverage While Traveling

document Header Blue Care Network (BCN) Coverage While Traveling

file:1453

Blue Care Network (BCN) HMO Benefits at a Glance

document Header Blue Care Network (BCN) HMO Benefits at a Glance

file:1451

Blue Care Network (BCN) HMO Summary of Benefits and Coverage

document Header Blue Care Network (BCN) HMO Summary of Benefits and Coverage

file:1825

Blue Care Network (BCN) Referrals

document Header Blue Care Network (BCN) Referrals

file:1459

Blue Care Network (BCN) Understanding the Referral Process

document Header Blue Care Network (BCN) Understanding the Referral Process

file:1452

Blue Care Network Rx Benefits at a Glance

document Header Blue Care Network Rx Benefits at a Glance

file:1932

CMS Notice About Your RX Drug Coverage and Medicaid 2021

document Header CMS Notice About Your RX Drug Coverage and Medicaid 2021

file:1842

Health Care Reform FAQ Getting Lower Costs on Coverage

document Header Health Care Reform FAQ Getting Lower Costs on Coverage

file:1457

Health Care Reform: Enrolling in Health Insurance Marketplaces

document Header Health Care Reform: Enrolling in Health Insurance Marketplaces

file:1458

Medicare Part D Notice 2023

document Header Medicare Part D Notice 2023

file:2031

Non Medicare Eligible Enrollment Form for Enhanced Benefits

document Header Non Medicare Eligible Enrollment Form for Enhanced Benefits

file:1855

Non-Medicare Eligible Retiree Coverage Selection Form July 2022

document Header Non-Medicare Eligible Retiree Coverage Selection Form July 2022

file:1840

Open Enrollment for Enhanced Non-Medicare Eligible Retirees

document Header Open Enrollment for Enhanced Non-Medicare Eligible Retirees

file:1841

Open Enrollment for Non-Medicare Eligible Retirees

document Header Open Enrollment for Non-Medicare Eligible Retirees

file:1843

Premium Assistance Under Medicaid and CHIP

document Header Premium Assistance Under Medicaid and CHIP

file:1454

Simply Blue 1500 Benefits at a Glance

document Header Simply Blue 1500 Benefits at a Glance

file:1450

Simply Blue 1500 Summary of Benefits and Coverage

document Header Simply Blue 1500 Summary of Benefits and Coverage

file:1829

Simply Blue 500 Benefits at a Glance

document Header Simply Blue 500 Benefits at a Glance

file:1449

Simply Blue 500 Summary of Benefits and Coverage

document Header Simply Blue 500 Summary of Benefits and Coverage

file:1828