Community College of Allegheny County (CCAC)

Community College of Allegheny County

Open Enrollment 2014–2015

For benefit eligible employees, 2014-15 Open Enrollment begins April 14, 2014 until May 9, 2014. Please submit forms to the Human Resources department by the deadline, May 9, 2014.  You may fax your form to 412-237-3135 and send the hard copy via interoffice mail.

 

Forms:

Enrollment Form

Change/Correction Form

Affidavit of Domestic Partnership

Termination of Domestic Partnership

 

Notices:

Children's Health Insurance Program Reauthorization Act of 2009 (CHIRPA)

Women's Health and Cancer Rights Act of 1998 (WHCRA)

Patient Protection Notice

 

Summary of Plans:

Keystone Blue HMO- Summary of benefits grid

Keystone Blue HMO- Summary of benefits and coverage notice (SBC)

PPOBlue- Summary of benefits grid

PPOBlue- Summary of benefits and coverage notice (SBC)

Dental Plan

Vision Plan

Focused Pharmacy Network