[Montgomery County, MD] 2025 Active Employee ONGOING Health and Life Insurance Election Form

Dear MCG Employee:

To complete your 2025 Health & Life Insurance Election form, please read the message below, check the box that you are willing to complete a digital version of the election form and proceed to complete your form online. TIP: Opening in Chrome as your web-browser allows for the best user experience.

Please use this enrollment form for the following reasons:

1. You are a new hire enrolling in health insurance plans within your initial 60-day window.

2. You have experienced a qualifying life event within the past 60 days and need to make changes to your 2025 benefit elections.

Qualifying life events are:

Marriage, divorce, remarriage
Birth or adoption of a dependent
Death of a dependent
Loss of coverage under another plan
Dependent's loss of coverage under another plan
Court-ordered custody of minor child(ren)
Moving out of your plan’s network area (applies to Kaiser participants only).

If your form and necessary documentation are submitted after the 60-day window, your request will be denied and you will need to wait until the next annual Open Enrollment to enroll and/or make changes to your plans.

Please attach the necessary required documentation before submitting this enrollment form. For more information about required documentation, click HERE. To upload, click on the attachment (paperclip) symbol on the bottom or left of the page (depending on your browser).

For more information about the Health & Life insurance plans, please visit the Office of Human Resources (OHR) Health Insurance Webpages.

After you submit your form, you will receive an email that your form has been submitted. This email acts as confirmation that your form was successfully submitted.

OHR will review and approve your enrollment transaction within 3-5 days. If any information is missing, you will be contacted on your County email. Once your elections have been approved, you will see your choices reflecting in ESS (self-service benefits).

ID Cards:

ID cards should arrive within 10-14 days. Insurance carriers are notified of enrollments once a week. Therefore, there will be a lag time between when you submit your form and you reflect in their system. Please wait to receive your ID card before scheduling any routine services. If you pay out of pocket for services Between your effective date and when you receive your ID card, you can file a manual claim to your insurance plan for reimbursement. If you are seeking emergent services before receiving your ID card, please contact OHR at 240-777-0311 to place a service request.

Please check that you agree before continuing.

By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.

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