CIGNA HD-HSA Enrollment

Enrollment Instructions:

1. Enroll by sending the CIGNA Enrollment form (below) to Daryl Dizenzo at CO.

2. Fill out the payroll deduction form (below) if you wish to have additional funds deposited in your HSA from your paycheck and send to Daryl Dizenzo at CO.

3. Fill out the online form to open a Health Savings account through CIGNA with JP Morgan Chase.

The Open Enrollment ID is NewCanaanPS2013

If you are not comfortable with the online form, please print and fill out the form below titled HSA CHase Bank Account paper application and follow the directions on the form. This form does not go to Daryl, it is mailed to the address on the form instructions.

4. CIGNA will be our new carrier for prescription drugs, MEDCO will be replaced on July 1, 2013. If you currently use MEDCO mail order system for your prescriptions, you may call CIGNA after July 1, 2013 and ask them to transfer your prescriptions. They will contact your doctor for you and obtain your prescription information to transfer into their own home delivery pharmacy. You will need to have the name and dosage of all your prescriptions when you call. 1-800-285-4812.

5. If you have a medical FSA, you must convert it to a Limited Purpose FSA to participate in the HSA. See the packet below titiled Limited Purpose FSA Guide and then contact Daryl Dizenzo at CO.