TO: All RCUH Principal Investigators & Employees
FROM: RCUH Human Resources
SUBJECT: RCUH Group Benefits Enrollment/Change Application Form (Form B-5) no longer valid – REVISED FORMS NOW AVAILABLE FOR USE
Effective immediately, the RCUH Group Benefits Enrollment/Change Application Form will no longer be used to process Group Health, Group Flexible Spending, and Group Life Beneficiary enrollments or changes. This form has been replaced by the following three (3) forms:
- B-5F Group Flexible Spending Enrollment Change Form B-5F Rev 03-02-15
- B-5H Group Health Enrollment Change Form B-5H Rev 03-02-15
- B-5L Group Life Insurance Beneficiary Form B-5L Rev. 04-07-15
Please also reference the full version of the respective policy below as we made minor changes:
- Policy No. 3.520 RCUH Health Plans
- Policy No. 3.530 RCUH Flexible Spending Plan
- Policy No. 3.540 RCUH Group Life Insurance
Forms may be submitted via email to RCUH_Benefits@rcuh.com or fax (808) 956-5022.
If you have any questions, please call (808) 956-3100.