TEAM SRC EMPLOYEE INSURANCE
  • Home
  • Contact
  • 2021 Renewal
  • 2021 Manager Renewal
  • 2021 Team Member Renewal

HEALTH INSURANCE OPTION 2

If you're wanting to review the Buy Up Plan, you're in the right place!

Buy Up Health Insurance Plan

Health insurance coverage is optional. You are not required to choose any health insurance coverage; however, you will still need to send in the Deduction Sheet and mark that you are refusing/waiving coverage. 
Picture
 This is our buy up plan.
If choosing this coverage, choose “Buy Up Option” on the
Employee Deduction Authorization sheet.
​​Children can be covered through age 25 if
you choose Employee/Children coverage.

If you elect to enroll in coverage, your bi-weekly payroll deductions will begin with the first paycheck in the
month that your insurance coverage becomes effective. It is important to remember that payroll deductions
are pre-taxed, meaning that they are deducted prior to any state/federal taxes being applied. This saves
you money, but also means that you cannot make changes to your selection unless you have a qualifying
status change, or until the next open enrollment. Be aware of this when making your decision.
Contact HR for a list of qualifying events. 
 If you would rather have insurance payroll deductions taken after taxes (after any state/federal taxes are deducted from your pay), please contact Tami Ashley in Human Resources at tashley@srcorp.org or 843.448.2646.

Enrollment Instructions

STEP 1: Click on the link below to review the plan and coverages.
2020 Buy Up Plan Information

STEP 2: Complete the Blue Cross Blue Shield Member Application below.
After reviewing the plan below, if you choose this coverage, you'll need to:
  • Fill out the application form.
    • Only complete the spouse and dependent information if you're buying health insurance for them.
      • Children are only eligible for coverage up to the age of 25.
  • Make sure each question is answered.
  • Sign and date the form.
  • Fax this form to HR at 1.888.462.2749.
Click on the link below to open and complete. Once complete, download to your desktop, print, sign and fax to HR at 1.888.462.2749.
2020 BCBS Member Application

STEP 3: Complete the Empoyee Deduction Authorization below. This form is required for enrollment.
To complete the form below:
  • Print your name at the top of the form.
  • The effective date is the first of next month.
  • Place a check by the Basic Plan.
  • Sign and date the form.
  • Fax this form to HR at 1.888.462.2749.
Click on the link below to open and complete. Once complete, download to your desktop, print, sign and fax to HR at 1.888.462.2749.
2020 Employee Deduction Authorization

STEP 4: Complete the Tobacco Surcharge Notice below. 
To complete the form below:
  • Print your name at the top of the form.​
  • Sign and date the form.
  • Fax this form to HR at 1.888.462.2749.
There is a tobacco/nicotine user surcharge of $35 per pay period in addition to your insurance payroll deductions. Tobacco/Nicotine usage includes cigarettes, pipes, dip, snuff, chew, e-cigarettes/vaping (or any other non-FDA-approved nicotine delivery devices.
Click on the link below to open and complete. Once complete, download to your desktop, print, sign and fax to HR at 1.888.462.2749.
Tobacco Surcharge Notice
  • Home
  • Contact
  • 2021 Renewal
  • 2021 Manager Renewal
  • 2021 Team Member Renewal