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New Employee Benefits Package
Human Resources

As a new employee, you have 31 days from your effective date of hire (first day worked) to enroll in benefits. Failure to elect coverage, including returning your completed enrollment forms during the enrollment period, may result in no coverage for a period of up to 12 months. Employees who do not meet this timeline must wait to enroll during the next open enrollment period.

     Adobe PDF  LBCC Benefits Eligibility Acknowledgement Form

The attached Employee Benefits Guide will give you an overview of all the Health and Welfare Benefits LBCC has to offer. 

    Adobe PDF  Employee Benefits Guide

A completed enrollment packet includes the following:

  Adobe PDF Kaiser Permanente (HMO) or Anthem/Blue Cross HMO Enrollment Form or Anthem/Blue Cross PPO Enrollment Form
  Adobe PDF DeltaCare (HMO) or Delta Dental (PPO) Enrollment Form
 

**No enrollment form is needed for the mental health and vision benefits. 
   Your enrollment is automatic
unless you are declining all benefits or declining the dental, mental health and
   vision of which you’d need to complete the health declination form. 

  Adobe PDF LBCC Group Term Life Insurance Enrollment Form

Adobe PDF Health Insurance Waiver Form (if declining any or all benefit plans)

Adobe PDF
Domestic Partner Affidavit

Optional and voluntary plans available to you include:

  Adobe PDF Section 125 Plans - Flexible Spending Accounts Enrollment Kit
  Adobe PDF Unum: Instructions for enrolling in Unum Voluntary Products, Short Term Disability, Long Term Disability, Life and AD&D Insurance, Evidence of Insurability Form
  Adobe PDF Savings and Retirement Plans: Tax Sheltered Annuity 403(b), Deferred Compensation Plan (DCP) 457(b)
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