2024 Non-Unit Dental Insurance Open Enrollment Form

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During October open enrollment, benefited Non-Unit employees may enroll for, terminate or modify coverage under the Non-Unit Dental Insurance Plan by returning a completed the Non-Unit Dental Insurance Open Enrollment Form to UMass Amherst Human Resources with proof of relationship* for each covered dependent. Completed forms and supporting documentation may be submitted:

• In person at the Human Resources Employee Service Center during hours of public operation
• Online via AskHR

Coverage changes made during open enrollment are effective the following January 1.  Premiums are payroll-deducted one month in advance of coverage. Employees contribute $22.88 monthly for individual coverage, $45.60 monthly for family coverage.

* If you wish to establish coverage for:

• Your spouse, please also provide proof of marriage.
• Dependent(s) under 26 years of age, please also provide proof of relationship (eg, birth certificate, documentation of adoption or placement with you in foster care).