Web-based Health/Benefit Enrollment

Exchange eBenefits

Choose Get Started.

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Exchange eBenefits
Employee chooses if they wish to take advantage of Section 125 tax break.

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Exchange eBenefits

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Exchange eBenefits
Personal Information is pulled from Exchange systems – Employee verifies all information is correct before
continuing.

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Exchange eBenefits
Screen when employee has no dependents in system.

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Exchange eBenefits
Screen when employee has dependents
Click on the dependent name you need to edit.

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Exchange eBenefits

Dependent edit screen

My Dependents
Your current dependents are listed belC7tV.
You may be subject to a $50 penalty from the IRS for each failure to provide an accurate SSN/ITIN for a covered individual. For additional information, see IRS Form W 9
instructions (available upon request).

(Spouse)
ArstName:
Middle Name:

-

■

Birth Date:

Ei

-

..,

Sex::

LastName:

Relationship:

..,

Spouse

Drop Down:
*Female
*Male

SSN:r-11111
D

Use my home address for this dependent

Line 1:

City:

Line 2:

State:

Line 3:

Zipc.ode:

y

Country:

y

I CANCEL 11 SAVE
I

Dependent Eligibility

Have a change in your family?

Learn more about who is an eligible dependent

Spouse➔
Sponsored Child ➔

Child➔

That change might allC7tV you to add or remove a dependent from coverage and
make updates to your benefits. It's called a famHy status change.

Initiate a Family Status Chani

Relationships include stepson and stepdaughter (these are defined as children), spouse, child, sponsored child.

Exchange eBenefits
Add a Dependent screen
My Dependents
Your current dependent information is listed below. To view more dependent details or to remove a dependent's coverage, click on the dependent name.
You may be subject to a $50 penalty from the IRS for each failure to provide an accurate SSN/ITIN for a covered individual. For additional information, see IRS Form W-9
instructions (available upon request).

Add DependE

New Dependent

First Name:
Middle Name:
Last Name:

Birth Date:

..,

Sex:

..,

Relationship:

Drop Down:
*Female
*Male

SSN:

D

Use my home address for this dependent

Line 1:

City:
State:

..,

Zip Code:
Country:

..,

Relationships include stepson and stepdaughter (these are defined as children), spouse, child, sponsored child.

Exchange eBenefits
Benefit Enrollment

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Exchange eBenefits
Begin Benefit Shopping Page: The Fast Lane

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Exchange eBenefits
Benefit Options – Fast Lane

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Exchange eBenefits
Bottom of Benefit Option Page

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Exchange eBenefits
Benefit Enrollment - Medical

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Exchange eBenefits
Benefit Enrollment - Dental

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Exchange eBenefits
Benefit Enrollment - HCFSA

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Exchange eBenefits
Benefit Enrollment - DCFSA

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Exchange eBenefits
Benefit Enrollment – Basic Life

Benefit Enrollment - Supplemental Life

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Exchange eBenefits
Benefit Enrollment - Spouse Life

Benefit Enrollment - Child Life

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Exchange EBenefits
Benefit Enrollment - Disability

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Exchange eBenefits
Benefit Enrollment - Personal Accident Insurance

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Exchange eBenefits
Beneficiary Summary showing no beneficiaries assigned

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Exchange eBenefits
Bottom portion of Beneficiary Summary screen

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Exchange eBenefits
Shows when employee has no beneficiary elected.

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Exchange eBenefits
Add Individual Beneficiary

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Exchange eBenefits
Add Estate Beneficiary

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Exchange eBenefits
Add Trust/Charity Beneficiary

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Exchange eBenefits
Shows when no beneficiary is designated.

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Exchange eBenefits
Select Allocations for beneficiaries by clicking on each product tab

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Exchange eBenefits
Benefit Confirmation Page

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Exchange eBenefits
Begin Benefit Shopping Page: Shop On My Own

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Exchange eBenefits
Medical - Overview

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Exchange eBenefits
Medical - Who Will You Cover

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Exchange eBenefits
Benefit Enrollment - Medical

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Exchange eBenefits
Benefit Enrollment – Health Savings Account (HSA)

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Exchange eBenefits
Benefit Enrollment – HSA Eligibility

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Exchange eBenefits
Benefit Enrollment– HSA Eligibility

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Exchange eBenefits
Benefit Enrollment - HSA Calculation

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Exchange eBenefits
Benefit Enrollment - HSA Calculation

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Exchange eBenefits
Benefit Enrollment – Dental

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Exchange eBenefits
Benefit Enrollment – Dental

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Exchange eBenefits
Benefit Enrollment– Dental

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Exchange eBenefits
Benefit Enrollment - Dental

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Exchange eBenefits
Benefit Enrollment – DCFSA

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Exchange eBenefits
Benefit Enrollment – DCFSA

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Exchange eBenefits
Benefit Enrollment - DCFSA

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Exchange eBenefits
Benefit Enrollment – Protection

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Exchange eBenefits
Benefit Enrollment – Life Insurance

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Exchange eBenefits
Benefit – Spouse Life

Benefit – Child Life

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Exchange eBenefits
Benefit Enrollment – Disability Income Program

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Exchange eBenefits
Benefit Enrollment – Personal Accident Insurance

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Exchange eBenefits
Benefit Confirmation Page

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