Health and Employee Benefits

NOTE: All forms for the 2021-22 Annual Benefits Open Enrollment must be submitted to Human Resources by the close of business of Friday, May 21, 2021 at 4:00 p.m.


Benefits Overview

Benefit Enrollment Form/Health Plan Waiver

Open Enrollment Notice

Open Enrollment FAQs

Annual and Affordable Care Act Notices

Summary of Benefits and Coverage - Yellow with Choice

Summary of Benefits and Coverage - Yellow

Summary of Benefits and Coverage - Orange

Health Insurance Marketplace Coverage Notice

403(b) Universal Notice

CHIP Notice

Benefit Rate Sheets

SchoolCare/Cigna Medical Plans

HealthTrust/Northeast Delta Dental

Medical Open Enrollment Documents

SchoolCare Annual Open Enrollment Notice

SchoolCare/Cigna Enrollment Guide

SchoolCare/Cigna Open Enrollment Presentation

SchoolCare/Cigna Enrollment/Change Form

Employee Assistance Program

Dental Open Enrollment Documents

HealthTrust Dental Benefits Overview

HealthTrust Enrollment/Change Form

Flexible Spending Accounts (FSAs)

Benefit Strategies Mobile App Directions

JREA/JRAO Exempt Forms


Non-Exempt Forms

Dependent Care Federal Tax Comparison

FSA Eligible Expenses

NH Retirement System

Pre-Retirement Beneficiary Designation Form

Life Insurance, Accidental Death and Dismemberment, and Long Term Disability

Life Insurance and Accidental Death and Dismemberment Enrollment Form

Life Insurance and Accidental Death and Dismemberment Beneficiary Change Form

Long Term Disability Enrollment Form

Privacy Notice

Term Life Benefits - Class 1: FT and PT Superintendents

Term Life Benefits - Class 2: FT and PT Administrators

Term Life Benefits - Class 3: FT Exempt Staff

Term Life Benefits - Class 4: PT Exempt Staff

Term Life Benefits - Class 5: Teachers

Term Life Benefits - Class 7: FT Non-Exempt Staff

Term Life Benefits - Class 8: PT Non-Exempt Staff

Change of Address Forms

Employee Change of Address Form

SchoolCare Change of Address Form

Health Trust Change of Address Form

NHRS Change of Address Form

Links to Benefits Websites

Cigna Health Care


Delta Dental

Benefit Strategies

The OMNI Group 403(b)

New Hampshire Retirement System

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