Open Enrollment Guide: Plan Year 2022
Open enrollment begins Monday, November 1, 2021 and ends Tuesday, November 9, 2021. All changes made during this time period will be effective beginning January 1, 2022. This is your only opportunity to make changes to your benefits unless you experience a qualifying event prior to the open enrollment period in October of 2022 for the 2023 plan year.
Please complete both steps below for Open Enrollment 2022.
If you need help accessing a form, please ask for assistance printing the form from the website.
You must turn your forms into central office NO LATER than TUESDAY, NOVEMBER 9, 2021. Acceptable methods of document return: PDF (via email), USPS (postmarked no later than November 5, 2021), or ENSU tray in the office at Canaan Schools.
Please follow BOTH steps below and return forms to complete Open Enrollment 2022.
STEP 1: Flexible Spending Account
Complete the HealthEquity FSA Enrollment/Decline form.
- You will need to fill out the top section with your personal information.
- If you are choosing to participate, please check the box indicating this and enter your total annual amount.
- Please indicate that you are opting both the debit card and direct deposit (it may be processed either way).
- Please print your name, sign and date at the bottom-most line.
If you are choosing NOT to participate, simply print your name, sign and date bottom-most line and check the "I decline to participate in the FSA plan" box.
Complete the HealthEquity FSA Enrollment/Decline form.
- Please fill out the top section with your personal information.
- If you are choosing to participate, please check the box indicating this and enter your total annual amount.
- Please indicate that you are opting for both the debit card and direct deposit (it may be processed either way).
- Please print your name, sign and date at the bottom-most line.
Note: If you are choosing NOT to participate, simply print your name, sign and date bottom-most line and check the ‘I decline to participate in the FSA plan’ box.
STEP 2: Healthcare
All school employees now fall under the Public School Employee Health Benefits CBA. VEHI has developed an excellent tool for you to navigate the changes. We highly recommend you review the Health Benefits CBA and utilize VEHI 2021 Decision Support Site.
If you don't want to make changes, you don't have to complete a form. Your current plan will continue.
You will need to complete the Health Insurance Enrollment Form.
- Fill out all personal information and new plan election in section 1.
- Check the box indicating open enrollment in section 2.
- If you are choosing to cancel your coverage at this time, please check voluntary cancellation in section 3.
- Dependents you are adding or removing in section 4.
- List secondary coverages, if any, in section 5.
- Sign in section 6.
To continue to refuse a health plan, you will still need to complete the Health Insurance Enrollment Form.
- Fill out personal information in section 1.
- Check the box indicating "refusal" in section 2.
- Sign in section 6.