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Benefits

 
 

PUBLIC SERVICE LOAN FORGIVENESS

InPersonFairFlyer2024

 

Need to add or remove coverage?

Adding or removing coverage for yourself or your dependents is as simple as completing and submitting the applicable form and some support documentation. Each insurance type (medical, dental, life, flex, vision) has its own form. Each insurance type has just one form ( except for flex has two) which is used to enroll, disenroll and/or make changes.  To locate forms  click on the applicable benefit on this webpage and then click to open the Forms section.  

The month of November each year is the St. Louis County/ARC Open Enrollment period.If you submit a change during and under open enrollment it will be effective the following January 1st.No support documentation is needed for coverage changes requested under open enrollment.If you are making changes outside of open enrollment there are many policies, rules, guidelines, statutes, and laws that govern your ability to make changes.You will need a mid-year qualifying event to qualify to make changes and you must request these changes within the applicable timeframe.You will always have at least 30 days from your qualifying event date to submit a form requesting a change.Some events allow more time.Inquire ahead of time to find out if you have more than 30 days.The most common mid-year qualifying events are listed below.If your change in circumstance is not listed below please inquire with Human Resources to see if you have a qualifying event.

Birth:

  • No support document needed to add coverage, copy of birth certificate needed to drop coverage
  • Don’t apply to add coverage for baby until you have baby's SSN
  • Coverage changes are retroactive to date of birth
  • Form adding child cannot be submitted prior to birth/adoption
  • Dental ONLY:  apply  within 3 years of date of birth to begin coverage the following month

Marriage:

  • Provide state and county of marriage on form
  • No marriage certificate required for coverage but provide a copy to your timekeeper if it involves a name change

Divorce:

  • Provide County and state of divorce, name and address of former spouse on form
  • No divorce decree required for coverage change but provide a copy to your timekeeper if it involves a name change

Loss of Other Coverage:

  • Submit form within 30 days even if you haven’t yet received the needed support document
  • Support document is typically a COBRA notice from your former plan but it can be a letter or screenshot that includes letterhead or logo, names, type of coverage and the date coverage is lost
  • Most insurance coverage does not end on the last day worked but goes through the end of the calendar month or longer.Don’t assume,ask and get documentation.

Gain of Other Coverage:

  • Submit form within 30 days even if you haven’t yet receive the needed support document
  • Support document is typically a benefit award letter but can be any letter or screenshot that includes letterhead or logo, names, type of coverage and date coverage was gained

Commencement or Change in Daycare needs or cost:

  • Only applicable to the Dependent Care Flex Account benefit
  • Submit form within 30 days of daycare costs starting, ending or changing

 

Contact

Sandra Kohn
Information Specialist II
218-720-1552
Email

Angie Rish
Information Specialist III
218-725-5067
Email

Beth Menor
Sr. HR Advisor - Benefits
218-725-5056
Email

All contacts

Ask A Benefits Question

Frequently used forms

Forms are fillable onscreen.  A few have a submit button but most have a signature field.  This field requires a wet signature.  Fill, print, sign, scan and send to submit. 

Medical Form

Dental Form

Vision Form

2025 Flexible Spending

Life & Disability Form

Evidence of Insurability Form 

Newhire Benefits Intake Form

Don't see your form above?  Choose your benefit type on this webpage and then the forms heading to find additional forms.