Open Enrollment

2021 Open Enrollment Instructions

Listed below are the benefit descriptions and enrollment forms for the Village’s benefit plans that are open for enrollment by eligible employees with a benefit effective date of July 1, 2021.  Information regarding the Employee Assistance Program (available year-round), and mandated annual benefits report information is also provided below. Please view the Open Enrollment Benefits Summary and Employee Rate Sheet before visiting the individual benefit topics:

2021 Benefits Summary

2021 Employee Rate Sheet

BCBS & Opt-Out Health Plans

  1. BCBS_ENROLLMENT GUIDE 2021
  2. BCBS_PPO_HMO_BAHMO_Enrollment Form
  3. 2021 Opt-Out Enrollment Form

Delta Dental Insurance

  1. Dental Enrollment Form (PDF)
  2. Dental Enrollment Guide (PDF)

VSP Vision Insurance

  1. VSP Benefit Summary 2021
  2. VSP Vision Enrollment Form
  3. VSP.COM - How to Create Your Own Account
  4. VSP DEP Plus Program
  5. Combat Digital Eye Strain

Annual Notifications

  1. Summary_of_Benefits_BAHMO_07-01-2021
  2. Summary_of_Benefits_HMOI_07-01-21
  3. Summary_of_Benefits_PPO_07-01-2021
  4. Health Insurance and Market Place Coverage
  5. COBRA NOTICE
  6. CHIPRA State Premium Assistance Notice
  7. HIPAA Privacy Policy
  8. HIPPA Privacy Notice
  9. HIPPA Special Enrollment Rights
  10. Medicare_Certificate of Creditable Coverage_2020
  11. Newborns and Mothers Health Protection Act Disclosure
  12. Womens Health and Cancer Rights Notification

Discovery Benefits FSA

  1. FSABenefits_Technology_Resources_Handout
  2. FSA Enrollment Form
  3. FSABenefits_Mobile_App_Handout
  4. FSA_Medical_and_Dependent_Care_Handout_2021

Supplemental Life Insurance

  1. The Standard Supplement Life Info
  2. The Standard Insurance Enrollment Form
  3. NCPERS Brochure
  4. NCPERS Enrollment Form
  5. NCPERS - Beneficiary Form

Express Scripts Rx Drug 

  1. 2021-ExpressScripts-Preferred-Formulary
  2. Express-Scripts-PreferredFormularyUpdate-4-1-21
  3. Generics Brochure
  4. ExpressScripts2021_Formulary_Exclusions-List
  5. ExpressScripts-ExclusionUpdates-4-1-21
  6. Smart90 for Maintenenace Medications
  7. Specialty Brochure
  8. Express Scripts Mobile App
  9. Mobile App Buckslip
  10. ESI Mobile App and Web - Print and View Member ID Card
  11. Home Delivery Buckslip

Other Benefits

  1. Aflac 2021 Open Enrollment
  2. Credit Union Flyer--Corporate America (PDF)
  3. Corp American CU Membership Application
  4. DuPage Credit Union Flyer 2 (PDF)
  5. The Standard EAP Brochure (PDF)
  6. EAP Services Overview