Election and Enrollment Forms
1. There are four forms on this page, but you only - for most times - need to complete the first form, the "Election Form". The Election Form is a consolidated Excel sheet that allows you to make benefit selections for all of the following benefits:
Anthem - medical plan
Principal - dental and/or vision plan
Principal - group life/ad&d and voluntary life plans
Section 125 - "POP" Pre-tax election for your medical, dental, and/or vision benefits.
2. By using this form you are agreeing to rules and qualifiers in the Anthem and/or Principal standard Enrollment Forms. (There is nothing unusual or scary there).
3. When you have completed the Election Form, please save it and email it to Ms. Sheila Thomas, HR Assistant/Benefits Manager at email@example.com. You may call her in the office at 770.602.0502 Ext 229.
4. Form #1: Here is the Election Form: Complete this form and email it to Ms. Sheila Thomas at firstname.lastname@example.org.
5. Forms #2, 3, 4: Here are the carrier enrollment forms and the Evidence of Health for Principal Voluntary Life Benefits when electing MORE THAN $50,000 in voluntary life. You only need to complete the Evidence of Health if electing more than $50,000 of voluntary life. If electing more than $20,000 for your spouse, you will need to complete an EOH form for them.