Annual Open Enrollment

April 7, 2021 – May 5, 2021

All enrollment forms must be received by
4:00pm on Wednesday, May 5, 2021

Forms may be sent any of the following ways:
fax – 978-374-3422
scan and email – jennifer.schmidt@haverhill-ps.org (Scan as a PDF using your phone – See below)
inter-office mail – Benefits Department
US Mail – Haverhill Public Schools, Benefits Department, 4 Summer Street, Room 104, Haverhill, MA 01830

*Benefit deductions for the 2021 – 2022 plan year begin May 28, 2021 paycheck

*Changes for the 2021- 2022 plan year effective July 1, 2021

Health Coverage

*ONLY submit an Enrollment Form if you need to make a change to your current benefit elections
*If you choose not to make any changes your current health and dental benefit elections will continue in the next plan year

FY22 GIC Benefit Decision Guide 2021 – 2022
FY22 GIC – School Bi-Weekly Rates
GIC Enrollment / Change Form
Required Documentation for Coverage

Dental Coverage

*ONLY submit an Enrollment Form if you need to make a change to your current benefit elections
*If you choose not to make any changes your current health and dental benefit elections will continue in the next plan year

Plan Summary
FY22 MetLife – School Bi-Weekly Rates
MetLife Enrollment Form

Flexible Spending Accounts (FSA)

*You MUST re-enroll each year
*KEEP your current debit cards
*Re-enrollment election will be loaded onto these cards as of July 1st

Plan Summary
Pro-Flex Enrollment Form

Health Care – $2750 per plan year (up to $550 carry-over)
Dependent Care – $5000 per plan year

Visit our website for more information
The pages will be updated frequently so check back often!
haverhill-ps.org/benefits

How to scan a document and email as a PDF with your phone:

iPhone:
Open the Notes App
Click bottom right to start a new note
Click the camera at the top of the QWERTY board
Hold phone over document and choose Scan Document
It will take a picture…you can adjust the corners…then choose keep document
Take your next pic until capture all documents
Click Save
Click the square with the arrow pointing up to send (top right)
Choose method – text, email, etc.

Android Phone:
Download the full Google Drive app (not the stand alone Sheets, Docs or Slides app)
Navigate to folder where you would like your scan to be saved
In the bottom right hand corner, there’s a floating action button with a (+) sign – Click this
The camera will open, and you’re ready to scan
Crop the image by sliding the blue dots around your document
The (+) button at the bottom of the screen lets you add another scan to the same document
The check mark is to save the document(s) you just scanned
Drive will automatically open the folder where you told it to save and upload it
Send your document in an email