Overview
Open enrollment for the 2024-25 school year will begin on May 6, 2024 and remain open until May 31, 2024 at 4:00 p.m. Please be sure to read the documents in this overview section for more information. Forms will be available in self-service on Frontline Central.
Benefits Overview
Open Enrollment FAQs and Save the Date
Benefit Enrollment Form/Health Plan Waiver
Annual and Affordable Care Act Notices
Summary of Benefits and Coverage - Yellow with Choice
Summary of Benefits and Coverage - Yellow
Summary of Benefits and Coverage - Orange
Health Insurance Marketplace Coverage Notice
403(b) Universal Notice
CHIP Notice
Benefit Rate Sheets
SchoolCare/Cigna Medical Plans
HealthTrust/Northeast Delta Dental
Medical Open Enrollment Documents
SchoolCare Annual Open Enrollment Notice
SchoolCare/Cigna Enrollment Guide 2024/25
SchoolCare/Cigna Open Enrollment Presentation
SchoolCare/Cigna Enrollment/Change Form
Employee Assistance Program
Summary of Medical Benefits
Dental Open Enrollment Documents
HealthTrust Dental Benefits Overview 3A Plan- JRSSA
HealthTrust Dental Benefits Overview 1S Plan-JREA, JRAO, SAU (Exempt and Non-Exempt)
HealthTrust Enrollment/Change Form
Flexible Spending Accounts (FSAs)
WEX Mobile App Directions
JREA/JRAO Exempt Forms
JRSSA Forms
Non-Exempt Forms
Medical Flexible Spending Information
Wex Benefits Card Information
Benefits Technology & Resources
Dependent Flexible Spending Information
Flexible Benefit Plan - Summary Plan Description
Adoption Agreement - Cafeteria Plan
JRCSD Formal Record of Action - July 1, 2016
JRCSD Formal Record of Action - May 5, 2021
NH Retirement System
Pre-Retirement Beneficiary Designation Form
Life Insurance, Accidental Death and Dismemberment, and Long Term Disability
Life Insurance and Accidental Death and Dismemberment/Long Term Disability (Combined) Enrollment Form
Mutual of Omaha Beneficiary Designation Change Form
Privacy Notice
Term Life Benefits - Class 1: FT and PT Superintendents
Term Life Benefits - Class 2: FT and PT Administrators
Term Life Benefits - Class 3: FT Exempt Staff
Term Life Benefits - Class 4: PT Exempt Staff
Term Life Benefits - Class 5: Teachers
Term Life Benefits - Class 6: FT Non-Instructional Staff
Term Life Benefits - Class 7: FT Non-Exempt Staff
403(b) Plan Documents and Forms
OMNI Group Adoption Agreement - January 1, 2019
403b Plan Hardship and Eligibility Amendments - January 1, 2020
403b Plan Document - January 1, 2019
Change of Address Forms
SchoolCare Change of Address Form
HealthTrust Change of Address Form
NHRS Change of Address Form
Links to Benefits Websites
Cigna Health Care
SchoolCare
Delta Dental
WEX Inc
The OMNI Group 403(b)
New Hampshire Retirement System