Retiree Open Enrollment

Please Note: The May 1-16, 2025 Open Enrollment period is for dental, vision, and non-Medicare health/prescription plans. Retirees enrolled in Medicare will have Open Enrollment in October for the Special Medicfill plans (with or without prescription coverage).
Title
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Retiree/Participant Open Enrollment Election Form
IMPORTANT
If you are over age 65 and/or enrolled in Medicare, the medical health plan enrollment section on this form does not apply to you. The "Pre-65 health plan election" is intended for your eligible dependents only.
This is the Retiree's UD ID Number.
xxx-xx-xxxx
To view your current benefits, log in to Web Views and select Flexible Benefits View under the Self-Service Section.

Please Note: The May 1-16, 2025 Open Enrollment period is for dental, vision, and non-Medicare health/prescription plans. Retirees enrolled in Medicare will have Open Enrollment in October for the Special Medicfill plans (with or without prescription coverage).

OPTIONS AND MONTHLY COST

Documentation is required when initially enrolling a dependent in a health plan. This includes a marriage certificate when covering a spouse, birth or adoption certification when covering a dependent child(ren), and a copy of their social security card through our Secure Document Submission site http://www.udel.edu/hrdocuments .

  • If you are enrolled in the Medicare Supplemental Plan, Special Medicfill, you have the option to enroll your dependent spouse under the age of 65 and/or eligible child(ren) in the non-Medicare health plan. 
  • If you are over 65 and are enrolling your under 65 spouse, select 'Individual'. 
  • If you are over 65 and are enrolling your spouse and children under age 65, select the option for Individual and Child(ren). 
 
  • If you are enrolled in the Medicare Supplemental Plan, Special Medicfill, and are not enrolling an under-65 spouse or dependent, select 'waive coverage'. Medicare Open Enrollment will be in the Fall 2025.
Monthly Cost of Aetna CDH Gold plan
Individual coverage (Retiree OR one eligible dependent) $57.02
Retiree and Spouse $118.24
Retiree and Working Spouse Surcharge $318.24
Individual (Retiree/individual) and Child(ren) $87.12
Family $150.23
Family with Working Spouse Surcharge $350.23
Monthly Cost of Aetna HMO plan
Individual coverage (Retiree OR one eligible dependent) $74.78
Retiree and Spouse $157.68
Retiree and Working Spouse Surcharge $357.68
Individual (Retiree/individual) and Child(ren) $114.40
Family $196.74
Family with Working Spouse Surcharge $396.74
Monthly Cost of Highmark BC Deductible PPO plan
Individual coverage (Retiree OR one eligible dependent) $44.08
Retiree and Spouse $91.20
Retiree and Working Spouse Surcharge $291.20
Individual (Retiree/individual) and Child(ren) $67.00
Family $114.00
Family with Working Spouse Surcharge $314.00
Monthly Cost of Highmark Blue Choice PPO plan
Individual coverage (Retiree OR one eligible dependent) $166.70
Retiree and Spouse $345.92
Retiree and Working Spouse Surcharge $545.92
Individual (Retiree/individual) and Child(ren) $256.92
Family $432.46
Family with Working Spouse Surcharge $632.46
If you are enrolled in the Medicare Supplemental Plan, Special Medicfill, you have the option to enroll your dependent spouse under the age of 65 and/or eligible child(ren) in the non-Medicare health plan. If you are over 65 and are enrolling your under 65 spouse, select 'Individual'. If you are over 65 and are enrolling your spouse and children under age 65, select the option for Individual and Child(ren).
If you are enrolled in the Medicare Supplemental Plan, Special Medicfill, and are not enrolling an under-65 spouse or dependent, select 'waive coverage'. Medicare Open Enrollment will be in the Fall 2025.

Working Spouse Surcharge (formerly Spousal Coordination of Benefits)

If you cover a spouse under your health plan, you are required to complete the Working Spouse Verification Form when the following events occur:

  • Enroll your spouse,

  • Anytime your spouse loses or gains employee coverage, and

  • Every year during the Annual Benefits Open Enrollment.

Retirees who choose to enroll a spouse in the university’s medical plan may be subject to a $200 per month surcharge. Please visit the Medical Insurance website at https://udel.edu/0013333 to find details about the Working Spouse Surcharge program and access the verification form.

Dependent Information

Select which plans you would like to elect for this dependent
Select which plans you would like to elect for this dependent
Select which plans you would like to elect for dependent 2
Select which plans you would like to elect for dependent 2
Select which plans you would like to elect for dependent 3
Select which plans you would like to elect for dependent 3
Select which plans you would like to elect for dependent 4
Select which plans you would like to elect for dependent 4
For new enrollments or to update your ACH Banking information, please complete and upload the Direct Payment Authorization form to the secure document portal http://www.udel.edu/hrdocuments

Health Plan Authorization

I understand that rights to service are subject to acceptance of my enrollment and to the terms and conditions specified in the present contract between the health insurance carrier and the University of Delaware. I certify that all information supplied by me is true. I, on behalf of myself and my covered dependents, authorize any physician, hospital or any other health care provider to release information available to them concerning any diagnosis, treatment or other health care services they render to me or my covered dependents to the health insurance carrier or its designee for purposes reasonably related to their contract or as required by law. I have read and agree with the above terms and authorize the University to collect premium contributions for remittance to applicable benefit carriers.

Type your name here

If this is the first time you are electing dependents for coverage, please submit the supporting documents through our Secure Document Submission site. 

If you have questions about this form or your benefits, please contact HR at hrhelp@udel.edu or call 302-831-2171.
 

Other Fields

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