Memorandums
- Memo to Benefits Eligible Faculty and Staff (PDF)
- Memo to Benefits Eligible Out of Service Area Faculty and Staff (PDF)
- Memo to Benefits Eligible Postdocs (PDF)
Medical Insurance
- Tufts Health Plan Insurance Enrollment Form (PDF)
- Open Enrollment Change Form (PDF)
- Tufts Health Plan Comparison (PDF)
- Change/Cancel Form (PDF)
- Tufts Health Plan Enrollment Kit (PDF)
- HIRD Form (PDF)
- Tufts HMO Value Summary of Benefits Coverage (PDF)
- Tufts HMO Premium Summary of Benefits Coverage (PDF)
- Tufts PPO Summary of Benefits Coverage (PDF)
Dental Insurance
- Delta Dental Enrollment Form (PDF)
- Open Enrollment Change Form (PDF)
- Change/Cancel Form (PDF)
- Delta Dental PPO Plus Premier Plan Description (PDF)
- Delta Dental PPO Plus Premier Plan Description Spanish (PDF)
- DeltaCare Plan Description (PDF)
- DeltaCare Plan Description Spanish (PDF)
2013 Rates
- 2013 Nonexempt Staff (PDF)
- 2013 Exempt Staff/Faculty/PostDocs (PDF)
- 2013 Same-Sex Domestic Partner Nonexempt (PDF)
- 2013 Same-Sex Domestic Partner Exempt/Faculty/PostDocs (PDF)
Flexible Reimbursement Accounts
- How does a Flex Reimbursement (also known as FSA) Account work? (Video)
- 2013 Flexible Reimbursement Accounts Enrollment Packet (PDF)
- Flexible Reimbursement Accounts Brochure (PDF)
- Crosby Debit Card Brochure (PDF)
- FSA Eligible Expenses (PDF)
Flu Shot Information
Other
Feedback
Open Enrollment
November 7 - 20, 2012
Where to send completed forms
Please return forms to the Office of Human Resources MS118 no later than November 20, 2012
- Mail – Interoffice (MS118) or US postal
- Drop off - Bernstein-Marcus, 2nd Floor
- Fax - (781) 736-4466
Please DO NOT EMAIL (scan) your enrollment/change form(s) due to the sensitivity of the personal information contained, i.e. social security number, date of birth, etc.
How to Make Changes to your Medical and/or Dental plans during Open Enrollment
Enrolling for the first time in medical or dental plan:
- Complete OE change form (PDF)
- Complete Tufts Enrollment Form (PDF) and/or Delta Enrollment Form (PDF)
Changing existing plan(s):
- Complete OE change form (PDF)
- Complete Tufts Enrollment Form (PDF) and/or Delta Enrollment Form (PDF)
Adding Dependents to existing plan(s):
- Complete OE change form (PDF)
- Complete Tufts Enrollment Form (PDF) and/or Delta Enrollment Form (PDF)
Removing dependents only from existing plan(s):
- Complete Change/Cancel form (PDF)
Terminating medical or dental plan (employee and dependents):
- Complete Change/Cancel form (PDF)
- Complete HIRD form (PDF)
Maintain current coverage medical and/or dental coverage:
- No Action Required
How to Enroll in a Medical and/or Dependent Care Flexible Reimbursement Account during Open Enrollment
Enrolling in a Medical and/or Dependent Care Flexible Reimbursement Account for 2013:
Flex Accounts do not roll over from year to year. If you are currently enrolled and want to continue your Flex Account for 2013 you must complete a 2013 Flex Account enrollment form.
Optional Forms
- If you have previously participated in Direct Deposit, you do not need to sign up each plan year. However, if you wish to make a change to this arrangement you must complete and submit a new Direct Deposit Authorization Form (PDF).
- Completed Crosby Direct Deposit Forms can be sent directly to Crosby Benefits by fax (617-928-0001) or mailed to:
Direct Deposit
Crosby Benefit Systems, Inc.
27 Christina St., Suite 200
Newton, MA 02461
Remember: This is the only time of the year when you may change health and/or dental insurance plans or enroll in a plan for the first time*.
This is the only opportunity to enroll in the Medical and/or Dependent Care Flexible Reimbursement Accounts for 2013*.
No Applications or Changes will be accepted after Tuesday, November 20, 2012. Coverage becomes effective January 1, 2013.
*Unless you have a qualifying change in status or other permissible event during the plan year.