NAF BENEFIT ORIENTATION CHECKLIST
03/2019
*Failure to make opt out of the defined benefit plan will result in an automatic enrollment in the Plan. Employee contributions will not be refunded until
employment is terminated or changed to flexible status.*
Important Affordable Care Act (ACA) information such as healthcare Marketplace coverage options and Individual Mandate requirements can be
found at www.nafhealthplans.com or at www.healthcare.gov to view the Department of Labor notice on the requirements of the ACA Individual Mandate.
□ I understand I only have 31 days from my date of hire/status change to enroll in the medical, dental, life, FSA and/or short term disability plans. □ I understand I can enroll or opt out of enrollment in 401k by contacting/notifying Fidelity the Wednesday following my 1st paycheck. □ I understand I only have 90 days from my enrollment date in the Group Retirement Plan to exercise my military service credit buy back opportunity. □ I understand I only have 31 days from my enrollment date in the Group Retirement Plan to exercise refunded service credit buy back opportunity. I have been advised of the benefits in which I am eligible to enroll: ____________________________________________________ ______________20___ Signature Date
Employee Eligibility Full-Time/Part- Time Non-Appropriated Fund Civilian Employees
Dependent Eligibility Who can be covered under medical, dental and life
Dependent Coverage Qualifications – age limits- required documentation and what documentation is required
Medical Plans Aetna or HMO
Aetna Medical Plan Aetna Choice POS II or Aetna International (Available at Japan commands only)
Health Maintenance Organization (HMO) Medial Plans
Coverage is available in specific locations (Hawaii, California and Mid-Atlantic) Kaiser and HMSA
JELLYVISON An interactive tool which explains all plans
Medical Premiums Medical premiums based on coverage and paid on bi-weekly basis
Dental Plans Aetna or HMO
Aetna Dental Plans Aetna PPO Dental or SAD
Health Maintenance Organization (HMO) Dental Plans
Coverage is available in specific locations (Hawaii) Kaiser and HMSA
Dental Premiums Dental premiums based on coverage and paid on biweekly basis
Premium Conversion (Section 125) Qualifying Life Events; Opting out of Section 125
Life Insurance Standard Life Insurance and Accidental Death & Dismemberment (AD&D)
Life Insurance Premiums Life premiums are based on salary. If unsure ask your HR representative for your premium
Optional Life Plans Optional life plans Opt 1 or Opt 2
Optional Dependent Life Plans Dependent Life 1, Dependent Life 2, Dependent Life 3 or Dependent Life 4
Optional and Dependent Life Premiums Optional Life is based on Age. Dependent life is a flat rate.
Flexible Spending Accounts (FSA) Healthcare FSA and Dependentcare FSA
Short Term Disability Disability Income replacement protection (AFLAC)
Long Term Care Plan Federal Long Term Care plan
Employee Assistance Program Magellan
*Retirement Plan NAF Retirement Plan. I elect to enroll in the NAF Retirement Plan on my date of hire ___Y___N
NAF Retirement Refund Buyback I received a refund for my prior Marine Corps NAF Retirement contributions. If yes let your HR rep know you may be eligible for a Retirement Refund Buy Back
___Y___N
NAF Military Buy Back I am interested in a former military Contributory, Military Purchased and Campaign (USERRA creditable service buy back.
___y___N
FERS Military Buy Back I am interested in a former military Contributory, Military Purchased and Campaign (USERRA creditable service buy back.
___y___N
401k Savings Plan Enrollment Options
401k & Pension Plan Comparison Retirement and Savings plans contribution and vesting information
Retirement Portability APF - NAF I Moved From Civil Service – NOTIFY YOUR HR REP KNOW IMMEDIATELY ___Y___N
Retirement Portability NAF – NAF Previous enrollment in other NAFI retirement plans (Air Force, Army, CNIC, AAFES or NEXCOM) prior refund? IF so NOTIFY YOUR HR REP KNOW IMMEDIATELY
___y___N
Benefit enrollment options 499 form or Peoplesoft Self Service
BENEFITS PARTICIPATION ACKNOWLEDGEMENT
This acknowledges that you were made aware that you have:
31 days from the start of your employment/eligibility date to elect participation in the MCCS
Medical Dental Life Insurance
30 days from the start of your employment/eligibility date to elect participation in the MCCS
Disability Protection (AFLAC)
60 days from date of employment/eligibility date to apply for participation in the Federal Long Term Care Insurance Plan (FLTCIP)
Failure to enroll in Medical or Dental within the 31 day eligibility period will result in no opportunity to enroll until the next designated open enrollment period. The only exception to this will be if/when you experience an eligible qualifying event (i.e., involuntary loss of coverage, divorce, etc). Qualifying events are determined by the Internal Revenue Service (IRS).
Failure to enroll in the Disability Income Protection Group plan during your 30 day eligibility period will require that you complete a short Health Care Application Form and be approved by applicable carrier prior to enrollment.
Failure to enroll in the Group Life Insurance plans during your 31 day eligibility period will require that you complete a short Health Care Application Form and be approved by applicable carrier prior to enrollment.
Enrollment in the FLTCIP requires eligible employees apply for enrollment within 60 days of attaining eligibility. Underwriting approval required prior to enrollment. Premiums are paid via direct bill to the FLCIP carrier.
________________________________________________________________________________
Signature Date
________________________________________________________________________________
Print Name
________________________________________________________________________________
HR Representative Date
REQUIREMENTS FOR ADDING DEPENDENTS TO MEDICAL/DENTAL/LIFE PLANS FOR 2012
Appropriate documentation must be presented when enrolling dependents into the NAF Benefit Programs. This applies to dependents of new hires, employees enrolling dependents during the Open Enrollment period and employees with status changes to a benefits eligible position. Children may be covered under an employee’s medical/dental plan up to age 26 regardless of whether they have access to other employer‐sponsored health care coverage. Documentation requirements are as follows:
HEALTH PLANS DEPENDENT CHECKLIST Listed below is the information required to add dependents to medical coverage. Employees are required to
provide evidence of that dependent’s relationship to the employee.
DEPENDENT DOCUMENTATION DATE RECEIVED To Add a Spouse Most Recent 1040 reflecting spouse as a
dependent
If newly married and 1040 is not available a marriage certificate is required
To Add children under age 26 Birth Certificate naming parent OR Adoption papers naming parents OR Official Court documentation naming
guardianship designation OR
1040 showing reflecting child as dependent
DEPENDENT LIFE PLANS CHECKLIST Listed below is the information required to add dependents to life coverage. Employees are required to provide evidence of that dependent’s relationship to the employee.
DEPENDENT DOCUMENTATION DATE RECEIVED To Add a Spouse Most Recent 1040 reflecting spouse as a
dependent
If newly married and 1040 is not available a marriage certificate is required
To Add children under age 19 Birth Certificate naming parent OR Adoption papers naming parents OR Official Court documentation naming
guardianship designation OR
1040 showing reflecting child as dependent To add children over age 19 ‐ 23 Birth Certificate naming parent OR Adoption papers naming parents OR Official Court documentation naming
guardianship designation OR
1040 showing reflecting child as dependent OR And Full‐time student status
DISSOLUTION OF RELATIONSHIP Listed below is information required to remove dependents from any type of benefits.
DEPENDENT DOCUMENTATION DATE RECEIVED Spouse Divorce Decree Children Divorce Decree Court Documents cancelling any
coverage obligations
REQUIREMENTS FOR ADDING DEPENDENTS TO MEDICAL/DENTAL/LIFE PLANS
SAME SEX DOMESTIC PARTNER HEALTH PLANS DEPENDENT CHECKLIST Listed below is the information required to add dependents to medical coverage. Employees are required to
provide evidence of that dependent’s relationship to the employee.
DEPENDENT DOCUMENTATION DATE RECEIVED
To Add a Same Sex Domestic Partner (SSDP)
Approved affidavit declaring Domestic Partnership or Marriage certificate for states that recognize same sex marriages
And proof of shared residence (utility bill or 1040)
To Add SSDP children under age 26 Birth Certificate naming parent OR
Adoption papers naming parent OR
Official Court documentation naming guardianship designation OR
1040 showing reflecting child as dependent
SAME SEX DOMETIC PARTNER DEPENDENT LIFE PLANS CHECKLIST Listed below is the information required to add dependents to life coverage. Employees are required to provide
evidence of that dependent’s relationship to the employee.
DISSOLUTION OF RELATIONSHIP Listed below is information required to remove dependents from any type of benefits.
DEPENDENT DOCUMENTATION DATE RECEIVED
SSPD Dissolution Affidavit or Divorce Decree(for states that recognize same sex marriages)
Children Dissolution Affidavit or Divorce Decree (for states that recognize same sex marriages)
Court Documents cancelling any coverage obligations
Dependents must be added within 31 days of a qualifying event; otherwise, they must wait for an open enrollment
period and submit supporting documentation.
DEPENDENT DOCUMENTATION DATE RECEIVED
To Add a Same Sex Domestic Partner (SSDP)
Approved affidavit declaring Domestic Partnership or Marriage certificate for states that recognize same sex marriages
And proof of shared residence (utility bill or 1040)
To Add SSDP children under age 19 Birth Certificate naming parent OR
Adoption papers naming parents OR
Official Court documentation naming guardianship designation OR
1040 showing reflecting child as dependent OR
To add SSDP children over age 19 ‐ 23 Birth Certificate naming parent OR
Adoption papers naming parents OR
Official Court documentation naming guardianship designation OR
1040 showing reflecting child as dependent OR
Birth Certificate naming parent
And Full‐time student status
LOG IN LANDING PAGE – CLICK THE BENEFITS TILE
IT WILL TAKE YOU THE BENEFITS SUMMARY PAGE
On this Page click on the Review/Update Your Benefits Link to the left.
The Benefits Information page will open and you can make your benefit elections
Click on the Edit My____ buttons to begin the enrollment process. Health Plan Elections:
Life Plans:
FSA Plans: