Anthem is the provider of health insurance for the Brunswick School Department. For available plans and benefit comparison, click here.
SECTION 125 CAFETERIA PLAN BENEFIT ELECTION FORM (dental/health premiums paid on pre-tax basis)
This cafeteria plan allows participants to make payments for certain employer-sponsored benefit plans with pre-tax dollars. By agreeing to reduce your salary by the amount of your contribution, you will generate Benefit Account Dollars which are not subject to FICA or federal and state income taxes. Any election you make to fund your benefits under the provisions of this plan will remain in effect until the end of the plan year unless one of the following family status changes occur, in which event an election may be revoked or changed.
- legal marital status including marriage, divorce, legal separation or annulment
- death of a spouse or death of a dependent child
- change in employment status (employee, spouse or dependent) from commencement of work, full-time to part-time or vice versa, unpaid leave of absence, strike or lockout or termination of employment affecting eligibility under an employee benefit plan
- a change in residence of the employee, spouse or dependent that affects eligibility coverage
- dependent satisfies or ceases to satisfy dependent eligibility requirements
When the above forms are completed, please return to Karen Thames in Payroll.