Open Enrollment Period: [Date]
Employee Information:
First Name
Last Name
Employee ID#
Middle Name
Job Title
These fields are all from the database.
Employee Social
Hire Date
Pay Frequency
Guaranteed Issue Period
Street Address
Email Address
City, State, Zip
Mobile or Home Phone:
Enrollment Info:
You have [$250] in flex allowance to spend each pay period.

Once Open Enrollment ends on [Date], you will not be able to enroll or change your elections until the next open enrollment period [next date].

Smartflex Benefits:
Benefit Guides:
*A Special Election period allows an employee to make changes to this plan, including joining the plan or cancelling the plan. Special Election periods occur when an employee has a new dependent either through marriage, birth or adoption or has a change to a dependent (such as divorce or death). Other Special Election periods may be allowed under your group health plan.