If you are making any changes to your health insurance elections, select and fill out the appropriate forms:
To complete the forms, print and fill in your information.
Completed forms may be scanned and emailed to email@example.com or printed and dropped off in HR. Paper copies of forms are available outside the HR Department.
Flexible Spending Account
You do not need to be enrolled in the medical plan to take advantage of the FSA!
With an FSA, you can set aside money from your paycheck before the government takes out taxes (usually 30% or more) to pay for healthcare and dependent child care expenses. You pay less in taxes. While you should only set aside enough money for those expenses you know you will incur during the plan year, the roll-over provision allows you to carry forward up to $500 into the next plan year for your healthcare FSA.
Employees can set aside up to $2,750 in pre-tax money for eligible health care expenses and up to $5,000 for dependent care expenses.
Don’t Forget – If you want to participate in the FSA you must re-enroll every year!
Short & Long Term Disability
CPH provides employees with employer paid Short-term Disability, optional additional employee paid Short-term Disability, and optional employer / employee paid Long-term Disability income benefits. In the event you become disabled from a non work-related injury or sickness, disability income benefits are provided as a source of income. You are not eligible to receive short-term disability benefits if you are receiving PTO, IAP, or workers’ compensation benefits.
Short Term Disability
May 24 – June 16th ONLY!
No evidence of Insurability is required to enroll in the Buy up for Short Term Disability for this year’s Open Enrollment. Simply complete the Short Term Disability Enrollment form, and return to HR no later than June 16th!
Long Term Disability
Long Term Disability provides a benefit of 60% of your monthly earnings (maximum of $10,000/month) if you are injured, and unable to after of period of 180 days. Coverage continues until you are able to return to work, or your normal Social Security Normal Retirement age. (See Plan Brochure for details)
Evidence of Insurability is required to enroll during an Open Enrollment period.
To enroll complete the Evidence of Insurability Forms and return them to HR.
Full-time and part-time employees are eligible to participate in the Life and AD&D insurance plan administered by New York Life. This benefit pays in the event of your death or the death of an eligible dependent. The plan also pays a benefit if you or an eligible dependent loses a limb, vision, speech, and hearing or dies due to an accident.
CPH pays the FULL COST to provide you with life and AD&D coverage equal to one times your annual pay if you are a full or part time employee.
During open enrollment you have the option of purchasing additional coverage for yourself or dependents.
Employee Life: May 24 – June 16th ONLY!
No evidence of Insurability is required to enroll in the Voluntary Life Insurance up to the Guaranteed Issue Amount (Guaranteed Issue for Employee is $80,000, Spouse $25,000) for this year’s Open Enrollment. Simply complete the Voluntary Life Enrollment form, and return to HR no later than June 16th!
- Employees may elect coverage in $10,000 increments to a maximum of $700,000 or 7 times your annual salary, whichever is less. Your election of $80,000 or less will not require evidence of Insurability, this open enrollment only!
- The amount of your benefit is reduced by 35% at age 65 and 50% at age 70.
- Spouse Life: You may choose to elect life coverage for your spouse in increments of $5,000. The Spouse Guarantee Issue $25,000. Your election of $25,000 or less will not require evidence of Insurability, this open enrollment only!
- If you choose coverage beyond that you will be required to provide satisfactory evidence of good health.
- Child/Children Life: You may choose to elect life and AD&D coverage for your child or children amounts of $1,000, $5,000 or $10,000 per eligible child.
Optional Accidentral Death& Dismemberment This benefit pays in the event of your death ,or covered member’s death, as a result of an accident, or if you or an eligible dependent loses a limb, vision, speech, and hearing or dies due to an accident
Accidental Death & Dismemberment can be increased / decreased during open enrollment, no evidence of insurability is required.
You can elect Coverage:
- for yourself in increments of $10,000 up to a maximum of, the lesser of ,5 times your annual salary or $500,000, or
- for your spouse, in increments of $5,000, up to $500,000, and/or
- for your children, in increments of $1,000, up to $10,000
To purchase additional coverage, complete the appropriate form below.
To learn more about the CPH Life Insurance Policy follow the link.
As always, you can access your Voya Retirement account at www.voyaretirementplans.com and make contribution changes at any time during the year. CPH does offer employer matching and discretionary contributions, in order to receive them you must be full or part time, have completed 1 year of service in which you worked 1000 hours, and you must be 21 years of age. Eligible employees receive an automatic 2% discretionary contribution base on the employee’s annual salary. Additionally CPH will match the employee contributions up to a maximum of 3% of employee’s salary.
If you have never enrolled in Voya, you can do so by following the directions provided on the Enrollment Flyer. Once you have enrolled, you can make changes to your retirement plan contributions by logging onto their website. You can also manage your investments, take loans, and access the educational tools that Voya offers.