Open Enrollment ~ 2024/2025

All changes

are due to the SAU

no later than,

Wednesday, May 29th

~ ~ ~ ~ ~ 

* Enrollment Forms Below *

What You Need to Do:

• If you would like to make a change, please fill out the appropriate form found below.
  • If you are NOT making changes to medical, dental and/or vision you do NOT need to complete an enrollment form.
• You need to complete a new flexible spending account form on an annual basis if you wish to participate. This benefit is not automatically renewed!

Choice Fund activation deadline:

• If you are enrolled in the Yellow Plan with Choice Fund, don't forget to complete your Health Assessment to activate Choice Fund. This can be completed from June 1st - July 31st. 

***** Enrollment Guide ***** - Includes required notices and easy to read open enrollment guidance

***** Open Enrollment Flyer *****

Please feel free to contact Christie Menard with any questions via email or (603) 526-9165

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ENROLLMENT FORMS

Flex Spending (must be completed if you want to participate in 24/25):

Health Account - IRS 2024 Maximum contribution is $3,200 ($640 rollover)

Dependent Care Account - IRS Maximum is $5,000 per household; $2,500 per person if married and filing separately

20 Deductions Enrollment Form (Teachers, Technology, Administration, Administrative Assistants, Facilities, SAU Staff)

18 Deductions Enrollment Form (Para-Educators and Interventionists)

Medical/Dental/Vision

Medical/Dental/Vision Enrollment or Change Form

403(b) 

List of approved Vendors

Salary Reduction Form 403(b)- OMNI

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MEDICAL PLAN INFORMATION

• Yellow Plan (with or without Choice Fund) Summary Chart - Quick View
• Orange Plan Summary Chart - Quick View
• Yellow Choice Fund SBC
• Yellow Plan SBC
• Orange Plan SBC

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MEDICAL PLAN VIDEOS

Yellow Plan With Choice Fund Overview

Yellow Plan Overview

Orange Plan Overview

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DENTAL PLAN INFORMATION

• Dental Core ($750) Teachers Option Only
• Dental High ($1,000) Teachers & Support Staff
• Summary Plan Description

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VISION (Hardware Assistance)

• Vision Plan Flyer

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FLEXIBLE SPENDING ACCOUNTS - Health and Dependent Care

• Benefits Tool Kit
• FSA Enrollment Video
• Medical FSA Handout
• Dependent Care FSA Handout