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Participating Agency Employees:

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).

All health insurance questions should be directed to OHR's MC311 Customer Service Center at 240-777-0311 (Mon-Fri 8 am - 5 pm) to open a service request.  A member of the health insurance team will respond to your service request in the order it is received.  TIP: Please provide an email address at the time you place your Service Request. This will ensure the fastest response possible.

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.

Participating Agency employees are employees who work for the following employers:
Arts & Humanities Commssion,
Town of Chevy Chase,
Housing Opportunities Commission,
Revenue Authority,
Strathmore Hall,
Town of Garrett Park,
Washington Suburban Transit Commission,
Bethesda Urban Partnership,
Town of Chevy Chase View,
Chevy Chase Village,
Village of Friendship Heights,
Montgomery Community Television,
Town of Somerset,
Maryland National Capital Park & Planning Commission (MNCPPC),
State Department of Assessment & Taxation,
Board of Appeals,
Montgomery County Volunteer Fire & Rescue Association,
Town of Glen Echo
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01/15/2025Click to Sign

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Additional Signatures Required

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