(Open Enrollment Dates: November 12 – December 12, 2012) All employees eligible for benefits MUST complete a Benefits Enrollment Form for 2013 (electronic form accessible through MYFranciscan employee login; or see Human Resources for a paper form) Reference Materials: Highmark BCBS HealthInsurance Coverage - Core Grid Highmark BCBS HealthInsurance Coverage – Buy-Up Grid Highmark Blue CrossBlue Shield Enrollment Application Highmark Blue CrossBlue Shield Member Change Form Davis Vision Plan Grid Affidavit to Add aNon-Dependent Child under the age of 26
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