Health Insurance, Beneficiary & Additional Forms

For New Participating Agency (PA) Employees

Below are important forms and and steps to follow to complete your onboarding.

1. Within two weeks of your hire date, complete the mandatory forms below:

   • Life Insurance Beneficiary Form
   • Salary, Annual & Sick Leave Beneficiary Form

   
   Success tips: Open the links in Google Chrome or Microsoft Edge for the best user experience.  Also, each Beneficiary Form’s cover letter contains important explanatory information. Read it carefully before naming your beneficiaries.

2. Explore your health, life, and flexible spending account options.

   Review the resources below to learn more about your options:

   • Health Insurance Orientation Presentation
   • 2024 Rates
   • Active Employee Health Insurance page
   • Plan videos

3. Within 60 days of your hire date, elect your health insurance options.

   You can select your health insurance plans by using the SeamlessDoc form below:

   • 2024 Participating Agency Health and Life Insurance Election Form

   
   Success tips:  By using Self-Service Benefits, you can immediately download a confirmation of your elections at the end of the process, which provides proof of your enrollment. However, your online enrollment will take a few days to process. If you need coverage starting on your hire date, use the 2024 Online Election Form instead.

Important Deadlines and Effective Dates

• There is a 60-day window from your date of hire to make your health insurance elections (31 days if electing between 1-4 x salary Optional Life). If you miss the 60-day deadline, then you must wait until the next annual Open Enrollment to enroll for the next plan year.
• Benefits do not become effective until the date you complete your transaction/form and supply any Required Documentation & Qualifying Life Events (PDF) within in the 60-day window.

For More Information

• For health and life insurance details, visit Active Employee Health Insurance
• For retirement plan details, visit www.montgomerycountymd.gov/retirement

If You Need Health Insurance Assistance

• Insurance Plan Contacts (PDF)