Open Enrollment Online System User Agreement Employee Enrollment Access Authorization (May 1 to June 14) Participating Employer:
Member #
1. As the employer, we elect to allow our employees to complete their annual Open Enrollment
Elections electronically effective May 1, 2015.
2. As a participating employer we can choose to enroll those who do not wish to use the online
system or forward the enrollment forms to the Center for Nonprofit Advancement’s Benefits
Trust by mail or fax for processing.
3. As the employer, we understand that we are responsible for reviewing all Open Enrollment
transactions between May 1 and June 14 for accuracy.
4. We agree that the information provided as part of the enrollment process may be stored by
the Center for Nonprofit Advancement’s Benefits Trust for reference purposes and
transmission to insurance companies. We may provide aggregate statistical information
about enrollments to our health plan providers and may use the information to inform you
about other publications, products, and services of the Center for Nonprofit Advancement.
5. This Agreement may be terminated by either party for any reason at any time.
The undersigned participating employer requests approval as a participant under the Center for Nonprofit
Advancement’s Benefits Trust, and hereby accepts and agrees to be bound by the terms of the “MEWA
Plan Document”. The undersigned hereby accepts and agrees to be bound by the participation
requirements of the Trust, which are set forth on this form, Summary Plan Description (SPD) and all
Multiple Employer Welfare Arrangement (MEWA) documents. Signing this form does not guarantee
coverage/insurability of employees using the online enrollment system.
Acknowledgement:
Signature:
Print Name
Print Title
Date
Employee Open Enrollment System
Employee Open Enrollment System
‡ The Employee Enrollment System user will need a computer with a
web browser and an active connection to the internet.
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Center will not provide this to any employee).
Quick URL link to the system:
http://www.nonprofitadvancement.org/OpenEnrollment (Click the apple)
2
Employee Open Enrollment System
You must enter:
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Member ID
2. Social
security number
3. Date of birth
(Your employer
must provide
their Employer
Member ID)
3
Employee Open Enrollment System
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Employee Open Enrollment System
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button to enter
the website
5
The system will
open up to show
the current active
plans.
If you are not
enrolled in a plan it
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You can change
plans offered by
your employer and
change your
coverage (i.e.
single to
employee/spouse).
Review to add or
drop new
dependents before
you change
coverage (see
instructions on
pages 9-11)
Employee Open Enrollment System
Click the drop down
button to see the
options available by
your employer
through health,
dental and vision.
You cannot make
changes to
voluntary life
insurance online.
See your employer
for additional
instructions.
6
Employee Open Enrollment System
You can print a
report before
you change
benefits.
7
Employee Open Enrollment System
You can update
your address,
work and home
telephone
numbers
8
Employee Open Enrollment System
Click this
button to
view current
dependents
Click this box to
edit dependent
information
(name)
Click this
button to add
a dependent
9
Employee Open Enrollment System
Add Dependent
You must add SS #,
first name, middle
initial, type of
dependent (child,
spouse or domestic
partner), sex and date
of birth (last name is
defaulted to the
employees last name).
10
Employee Open Enrollment System
Edit Dependent
information
You can edit SS #,
name, sex, date of
birth and date of
marriage (last name is
defaulted to the
employees last name).
11
Employee Open Enrollment System
Make sure you
save any changes
you make to your
benefits
12
Employee Open Enrollment System
Sample
The dependent
now enrolled in
medical coverage
effective July 1.
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