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2021 Retiree Open Enrollment Form 

Open Enrollment closes Friday, October 30, 2020. The Retiree Open Enrollment form will be removed from this page on October 30, 2020. You will receive a copy of your submitted form to the email address you use when completing the form. A valid email address is required to complete the form. 

For questions about retiree open enrollment email Retiree Open Enrollment.

All open enrollment elections will have a January 1, 2021 effective date.

Important: if completing the  form using an Apple mobile device, such as an iPhone or iPad, please follow the instructions on the top of the form submittal page regarding opening in a new tab. 


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