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Benefits Forms

2017 Standard Employee Benefit Program
New regular full time Dickinson Fleet Services employees are eligible to participate after 60 days of employment and forward to the 1st of the next month. Our standard benefit program includes Medical, Dental, Vision, Flexible Spending, GAP, Long Term Disability and Voluntary Employee Life & AD&D, Spouse Life and AD&D and Child Life insurance.

401(k) Plan
New Regular Full Time Dickinson Fleet Services employees are eligible to participate in the 401k Plan after 90 days and forward to the 1st of the next month. This is a voluntary benefit. If you do not want to participate you must waive this coverage. Per DFS 401k Plan guidelines, employees are automatically enrolled at 3% if initial enrollment is not waived. After the initial enrollment deadline, all eligible employee may enroll in 401k at any time.

Enrollment Mandatory Forms
1. UMR Enrollment Form is a required form for all employees to complete. All newly eligible employees must elect or waive this coverage per the Affordable Care Act Guidelines.
If you elect to waive both the medical and dental
o You must provide your current benefit Carrier Name, Policy Holder Name and Card Number on the UMR form.
If you elect one or both of these benefits
o You must submit an Ameriflex Premium Only Plan Form. This form lets payroll know if you want the premiums paid for these benefits to come out of your paycheck pre or post tax.
If you elect to carry your spouse on the DFS medical plan
o You must submit the Working Spouses Form. This forms confirms that your spouse qualifies to participate in this benefit. A spouse cannot be coverage on the DFS medical plan if they are working and their employer offers medical insurance to them.

2. Sun Life is a required form from all newly eligible employees
• All DFS fulltime employees qualify for Short Term Disability and Basic Life and AD&D Insurance coverage at one times their annual base earnings.
• Beneficiary information is required on this form.

Voluntary Benefits
• Vision, Flexible Spending and GAP
o These benefits forms do not need to be submitted if you are NOT electing to patriciate in the benefit.
• Sun Life
o This form must be submitted due to employees automatically receiving Short Term Disability and Basic Life and AD&D at the expense of the company.
o Long Term Disability and Voluntary Employee Life & AD&D, Spouse Life and AD&D and Child Life insurance are also available to employee on this form and they are voluntary
 You must decide to enroll or decline these benefits
 If you choose to enroll please contact HR Benefits or Payroll for a Premium Quote






Enrollment FormsLink
Medical and Dental Insurance - UMRLink
Ameriflex Premium Plan Only - AmeriflexLink
Working Spouses Form - DFSLink
Vision Insurance - VSPLink
Flexible Spending Account - AmeriflexLink
GAP Insurance - AssurantLink
Life and AD&D Insurance, Long and Short Term Disability – Sun LifeLink
401(k) Enrollment - PrincipalLink
UMR - Formulario de inscripción / cambios del empleadoLink

Benefits SummaryLink
DFS Benefit Cost 2017Link
UMR Medical Benefit and Coverage SummaryLink
UMR Dental Plan SummaryLink
VSP Vision Plan SummaryLink
AmeriFlex Flexable Spending Account (FSA) Plan SummaryLink
GAP Assurant Plan SummaryLink
Sun Life Employee Benefit BookletLink
Sun Life Employee Rate Endorsement Employee Life and AD&DLink
Sun Life Employee Rate Endorsement Long Term DisabilityLink