A. Medical Plan Enrollment/Change

1. Complete Pace University Benefits Election Form which is available on our website at www.pace.edu/hr under forms
2. Complete enrollment or change form for your medical plan carrier (contact Benefits Office/Human Resources)
3. If you are enrolling in an HMO, you must indicate a Primary Care Physician. Please visit the medical carrier website for participating providers
4. Make sure both forms are dated and signed

B. Delta Dental Plan Enrollment

1. Complete Pace University Benefits Election Form, which is available at www.pace.edu/hr
2. Complete Delta Dental Enrollment Form, which is available at www.pace.edu/hr
3. If you are electing either the NY or NJ DeltaCare DMO plan you MUST indicate a dental care provider on the enrollment form.
4. You can check if your dentist is in DeltaCare by accessing the Delta Dental website at www.midatlanticdeltadental.com
5. If you are electing the Delta Preferred POS, you do NOT need to elect a dentist
   Make sure both forms are dated and signed

C. Life Insurance Enrollment/Change

1. Complete Pace University Benefits Election Form
2. Complete Sun Life Optional Enrollment Form to increase or decrease your coverage level. This form is available on the Human Resources website at www.pace.edu/hr under “Forms”
3. Make sure both forms are dated and signed

D. Flexible Spending Accounts

If you want to be enrolled in a Flexible Spending Account during 2003, you must complete the appropriate form. FSA enrollments do NOT “roll-over” from previous plan years.

1. Complete Pace University Flexible Spending Account Enrollment Form for the plan year January 1, 2003 to December 31, 2003.Please do not use forms from previous plan years. This form is available on the Pace University website at www.pace.edu/hr under “Forms”
2. Make sure form is dated and signed

To obtain medical carrier enrollment forms or if you have questions regarding enrollment, please contact Kim Estremera in the Benefits Office at x2786 (914-923-2786) or via e-mail at kestremera@pace.edu

The Benefits Office must receive all completed forms by December 11, 2002. No exceptions will be made.