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Dear MCG Employee:

To complete your 2025 Health & Life Insurance Open Enrollment 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 making your 2025 Open Enrollment elections, if you are unable to use Employee Self-Service (ESS). All changes will be made effective January 1, 2025.
Please attach the necessary required documentation before submitting this enrollment form. 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.


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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Upload Attachment(s)

Please upload the necessary required documentation (i.e. marriage and birth certificates).  Click HERE for more information on required documentation.

If you have more than one child and need to provide multiple birth certificates, it is recommended that you combine all of the birth certificates into one document before attaching. 

There is a 250MB limit on each attachment.

Official state marriage certificate (certified by appropriate state or county official) Click Here to Upload
State birth certificate Click Here to Upload
Adoption or placement for adoption papers Click Here to Upload
Medical plan verification of disability prior to age 26 (For disabled dependent over 26) Click Here to Upload
Court order granting legal custody (legal guardianship) Click Here to Upload
Proof of new/cancelled coverage documentation (Gaining/losing coverage elsewhere) Click Here to Upload
Death certificate Click Here to Upload
Divorce Decree Click Here to Upload