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Benefits Enrollment

Benefits Enrollment

Learn more information about HACC's benefits as well as how to enroll.

 

Plan Information

Plan Costs

Comparing the Plans

Plan Contact Information

 

After you complete your enrollment, be sure to complete and submit all required forms to:
Office of Human Resources
TL205

  • Spousal Surcharge Form (pdf)
    • Complete this form every year if you are covering your spouse on your medical plan.
  • Medical Cash Opt-Out Form (pdf)
    • Complete this form every year and submit proof of other coverage if you are waiving HACC's medical coverage. You will not receive the $1,500 waiver until both the form and proof of other coverage are received.
  • Evidence of Insurability Form (pdf)
    • Complete this form only if you are increasing your coverage or enrolling in Voluntary Life or AD&D for the first time.
  • Dependent Verification (pdf)
    • Submit this information only if you are enrolling a dependent for the first time.
  • Domestic Partner Affidavit (pdf)
    • Complete this form only if you are adding a domestic partner for the first time.

 

Legal Documentation

  • Medicare Notices (pdf)
  • Annual Legal Notices (pdf)
     

Contact Human Resources

AskHR@hacc.edu
717-736-4124