Separation Election for Benefits Coverage

Resigning or retiring soon? It is very important that you read this notice in its entirety so that you are fully aware of your options and the impact on your benefits and final pay.

• If you are enrolled in Medical, Dental, or Vision health benefits or the Health Savings Account (HSA), you have the choice to terminate your benefits at the end of the month in which you resign/retire OR extend your coverage through August 31st. Please complete the "Separation Election for Health Insurance Coverage Form” via the link below.  If the form is not received, your benefits will terminate on August 31st, and premiums will continue to be collected through your final paycheck. If the remaining premiums exceed the final paycheck, benefits will be terminated at the end of the month before the month in which premiums cannot be collected.
• For coverage beyond the last day of the month in which you resign/retire, up to August 31st, the premiums due through your benefits termination date will continue and will be collected through your final paycheck.
• If you complete your contract and are enrolled in the Medical Flexible Spending Account (FSA) or the Dependent Care Account (DCA), your remaining contributions will continue via payroll deduction and through your final paycheck. Please note that if you do not extend your health benefits to August 31st, your FSA and/or DCA will remain active, and the deductions are not optional.

Individuals enrolled in all other voluntary benefits not listed above will have those benefits terminated effective on the last day of the month in which you resign/retire. Portability of coverage is available on some products, and we are happy to discuss these options with you.

Should you have any questions, please email Benefits@galenaparkisd.com.