Making Medical Plan Changes
Use these forms to make medical plan changes. The housing authority must complete one copy of the Benefits Election Form and each employee must complete an Employee Enrollment/Change Form. Only address the medical plan change. Do not include any other coverages you may have with HBP on this form. Please contact Susan Strange if you have questions at 318-377-9268 or email@example.com. Submit these forms to Susan by email or fax to 318-371-1224. Please follow the instructions on the forms to complete them. Housing authorities with brokers should not use these forms as the rates on these forms do not reflect rates with commission.
Example Benefits Election Form for changing to the Premier PPO plan
Example Benefits Election Form for changing to the Value with Premier Rx plan
Example Benefits Election Form for changing to the Value Full PPO plan
Do not include other changes due to Open Enrollment on these forms. Employees should complete a separate Employee Enrollment/Change Form for that and submit it to Mercer at CBS.HBP.Billing&Eligibility@mmc.com or fax it to 319-887-4220.
To enroll an employee or to make employee changes please complete the attached enrollment/change form and send it to your current Mercer contact.
Email it to CBS.HBP.Billing&Eligibility@mmc.com or fax it to 1-319-887-4220.
Crystal Ruth (515-365-1114) is the contact for housing authorities in Alabama, Arkansas, Florida, Georgia, Kansas, Louisiana, and Missouri.
Alicia Schossow (515-365-1013) is the contact for housing authorities in Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas.
Life Insurance Information