The below form should be completed for all new enrollments or changes.  Please fill out the form by clicking the link and submitting it when done.
 

• Enrollment/Change Form  

 
If you have Medicare Part A and B, please complete the Aetna Medicare Advantage form or the KelseyCare Advantage form by clicking the appropriate link of choice below. When submitting one of these forms, the Enrollment/Change form above must be submitted as well for a complete enrollment.
 

• Aetna Medicare Advantage Form
• KelseyCare Advantage Form

 
Open enrollment will starts July 24, 2024.
You can enroll online or at the Trust Office. The office hours to enroll are Monday through Friday from 9:00 am to 4:30 pm. This enrollment is to make changes Only. As a retiree/surviving spouse, if you choose to terminate your coverage; you are not eligible to re-enroll at any future date. The last day to enroll or make changes si August 16, 2024. No enrollments will be accepted after August 16, 2024. Click to see flyer for details.

Please click the links below to download current rates, schedules, and additional information and forms for your health benefits:
 

***Dental enrollment (online only) January 1-31st.  Click here for more details!

• Current Rates
• Medical Benefit Summary
• Common-Law Certificate
• Retirement Exit Form
• Adding Dependents – Guidelines
• Qualifying Events Per HIPPA Law