Open Enrollment

 Benefits Open Enrollment 2015


We are pleased to announce the start of the 2015 Benefits Open Enrollment period at Lafayette College.  The Office of Human Resource’s offers one combined Open Enrollment period for your medical, dental, flexible spending, supplemental life insurance coverage, and vision coverage.

This year’s Open Enrollment begins on October 28, 2014 and continues through November 18, 2014. During Open Enrollment, employees may make changes to their benefits plans.  All of the plans offered during the Open Enrollment period are based on a calendar year (January 1, 2015 through December 31, 2015); therefore changes made during this period will be effective on January 1, 2015.

During Open Enrollment, you can make changes to your benefit plans without having to show evidence of a “life status change”.  Once you have made your elections, you cannot change them during the plan year unless you experience a life status change event as qualified under IRS regulations Section 125.


 Please refer to the Open Enrollment Brochure for all information regarding Open Enrollment for 2015:

Link to 2014 Open Enrollment Brochure update


The college has selected Highmark Blue Shield as our health insurance carrier for 2015.  Dental insurance will remain with Blue Cross Dental and continued to be administered by Capital BlueCross. The college has selected Discovery Benefits as its Flexible Spending Administrator for 2015. Detailed information can be found in the Open Enrollment brochure.

Premium Rates – 2014 – change


The following is a link to Lafayette’s Highmark Blue Shield webpage.  This customized site provides information and forms for employees enrolling in, or making changes to their medical coverage for 2015.

add link

 Enrollment Application

Enrollment-Waiver Form

Enrollment Template

Because the college is changing its health insurance carrier for 2015 and offering three brand new medical plans we are requiring all employees to complete a Highmark enrollment form for 2015  Employees who are declining medical coverage must complete the Highmark Option to Waive Medical Dental Coverage Form.

For dental coverage the following is a link to Lafayette’s Capital BlueCross webpage.  This customized site provides information and forms for employees enrolling in, or making changes to their dental coverage for 2015.

 Link to Capital BlueCross 

Application to Enroll or Change Dental Enrollment 

If you are remaining on dental coverage for 2015 with no changes to dependents, you do not need to complete a new  Capital dental Enrollment Form.


 Flexible Spending Accounts

The college has selected Discovery Benefits as its Flexible Spending Administrator for 2015.

Understanding Your FSA

Frequently Asked Questions

FSA Employee Guide

 A new flexible spending enrollment form, Flexible Spending Account Form, is needed for all employees enrolling in this program for 2015.  Additionally, if you are selecting Dependent Care for 2015 you may complete the Recurring Dependent Care Request Form.

The following documents will serve as a guideline when using your Flexible Spending Debit Card.

Guide to Substantiating Debit Card Transactions

Guide to the Benefits Debit Card 


 Optional Life Enrollment

Eligible employees are able to buy or increase their Supplemental/Optional Life coverage in increments of $10,000, up to 5 times their annual salary, not to exceed $500,000. Employees who are currently enrolled in optional life (at any amount) would be eligible to increase their optional life insurance by $20,000, without evidence of insurability, during this and future open enrollment periods.

Optional/Supplemental Life Enrollment Form (PDF)

Optional/Supplemental Life Enrollment Form (DOC)


Additional Forms

Below is an additional links, to the various forms and plan information, that also pertain to your benefit selections during the 2015 Open Enrollment period.


Medicare Part D Creditable Coverage Notice – Lafayette College