Benefit Forms
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Open Enrollment will begin on Monday, July 28th and end on Friday, August 8th. Open Enrollment is your annual opportunity to make benefits changes without a qualifying event. Benefits staff is available all summer and is currently accepting open enrollment changes to be processed in August. If you have any questions, please contact Benefits staff to set up a meeting to discuss your benefits options.
To make changes to your current coverage (or elect coverage) outside of Open Enrollment, you must have a HIPAA qualifying event, for additional information, please refer to the 2024-2025 Benefits Booklet or 2024-2025 Medical Guide.
Enrollments/changes must be completed within 31 days of event (new hire (start date), FTE changes, child/spouse dependent eligibility such as marriage, birth, or adoption). Forms can be submitted directly through the submission portal (MyFSD email is required for online submissions) or by downloading the document, completing it, and uploading to the Benefits Dropbox. Please contact Benefits if you have any questions.
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New Hires or New Enrollment
Please only complete and submit forms for plans you will be enrolling in. District Sponsored Benefit Eligible employees are required to enroll in District paid Basic and AD&D Life Insurance. Life Insurance enrollment form is included in the New Hire Enrollment files below;(MyFSD email is required for online submissions) -
Adding / Terming Dependent (Open Enrollment or Qualifying Event)
Due to qualifying event (documentation must accompany forms). Please complete the applicable forms in the link below and attach required documentation for processing within 31 days of qualifying event. Failure to submit all documents within 31 days of qualifying event will result in loss of eligibility to enroll or make changes. Please see link below for more information. If you would like to update your Life Insurance beneficiaries, please see Life Insurance Link for more information.(MyFSD email is required for online submissions)
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Part Time Benefit Eligible Employees, Waiving/Declining coverage ONLY (if you will be enrolling dental, vision, and/or medical please refer to New Hire or New Benefit Eligible Employees section above)
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If you wish to decline/waive all of your benefits, please complete the link below titled Waiving Coverage. If you only choose to decline/waive some of your benefits, please complete the appropriate enrollment form(s) for coverage you would like to elect (enrollment forms can be found above under New Hire/Eligibility section).Please note if you are a part-time employee (50% or greater / 4.0 hours or greater) and waiving all or some of your benefits you are still required to enroll in Basic Life Insurance, as it is completely paid by the district and at no cost to you.(MyFSD email is required for online submissions)
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