Open Enrollment 2022
Open Enrollment is on!
Below you will find links to the open enrollment Benefit and Video Guides for Michigan and Arkansas.
Additional enrollment materials are located in the lunchroom onsite. All of the following enrollment forms must be completed and signed in ink and returned promptly to HR.
• Pontiac Coil Enrollment Form (even if you waive insurance)
• Tobacco and Nicotine declaration page
If choosing an HSA, also turn in the:
• Priority Health application (unless not electing medical coverage)
• Mutual of Omaha application (if changing voluntary life coverage)
• Fidelity Beneficiary form
If you waive insurance it is your responsibility to provide proof that you are insured elsewhere to receive the opt-out benefit.
Please remember to complete your enrollment forms fully.
This includes address/phone/birthdates/social security numbers for you and dependents.
Pontiac Coil – Clarkston