1) I have reviewed the 2024 Benefits Guide and I don’t have any changes in my benefits enrollment for 2024.
2) If waiving health insurance coverage at this time, I understand I will have to wait until the next open enrollment period to enroll in any of the Plans, unless I have a change in status/qualifying event. If I experience a change in status/qualifying event, I must notify human resources within 31 days of the change in status/qualifying event and provide applicable supporting documentation.
3) I hereby authorize deductions from my pay of the amount required for the insurance indicated in the 2024 Benefits Guide.
4) I have reviewed the Benefits Guide and rates for the coverage(s) and understand the rates for deduction.
5) In the event of a rate change, I understand that the township will send notification of a rate change and I authorize a corresponding change in the amount deducted from my pay without signing a new authorization form.
6) I understand that the township will deduct any medical premiums pre-tax under Section 125 Benefit Plan unless I elect to opt-out of pre-tax deductions.