Plan Enrollment & Waivers

Anthem BCBS EPO & PPO Medical
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Anthem BCBS Vision

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Delta Dental PPO

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Eligible individuals declining any type of  coverage must sign a waiver for each coverage type.

 

Individuals Who May Be Eligible

Employee

Spouse

Children/Dependents 

Coverage Types

Medical

Dental

Vision

Example:

An employee, the employee's spouse, and their two children are eligible to enroll in health benefits. 

   >  The employee and one child want to enroll in medical coverage only.

​   >  The spouse and other child must be listed on the medical waiver​.

   >  All 4 family members (employee, spouse and 2 children) must be

       listed on the dental and vision waivers.