[Montgomery County, MD] 2025 Retiree Election Form

Dear MCG Retiree

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.

Forms are due on the 10th of the month and changes will become effective on the first of the month following.

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).

Enrollment in Medicare Parts A and B is required for all retirees and covered dependents when they become entitled to Medicare. Medicare entitlement occurs for most people the month they turn age 65. However, there are other reasons that you or your covered dependent can become entitled to Medicare earlier than age 65, such as Social Security Disability, End-Stage Renal Disease, etc. Our office sends out a communication in advance of the 65th birthday to explain what action is required by the retiree or covered dependent. If you or your covered dependent become entitled to Medicare for other reasons than turning age 65, it is your responsibility to make sure that you and/or your covered dependent enrolls in Medicare Parts A and B upon entitlement and you must notify the Office of Human Resources and provide a copy of your Medicare ID card via one of the methods below:

Mail to: Office of Human Resources, 101 Monroe Street, 7th floor, Rockville, MD 20850

Fax to: 240-777-5131

Email to: OHR.HITS@montgomerycountymd.gov

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.

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.

If you are enrolling in the Fully Insured Vision plan, please note that your new vision ID card will not arrive until after your new effective date due to the vision vendor's enrollment lags.

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.

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