Retirement Benefits Checklist Pre-65

If you are considering retirement, one to two months prior to your retirement date, please reach out to Human Resources to pick up your retirement packet and initial benefit process overview.

Please complete this checklist and submit it to Human Resource two to three weeks prior to your proposed retirement date.

First

Last

Retirement Date

Which medical benefit option would you like to elect?

CDHP 1

CDHP 2

CDHP 3

Waive medical

Please select coverage level

Employee Only

Employee + Spouse

Other

Would you like to elect dental coverage?

Yes

Would you like to elect vision coverage?

Yes

Have you completed and submitted the following to Human Resources:

VEBA Direct Deposit Authorization Form

Sun Life Beneficiary Designation Form

富二代视频app University Fully-Insured Retiree Health Plan VEBA Beneficiary Designation Form

Continue to use your existing medical card(s) until your new card(s) arrive in the mail, approximately 2 weeks. You will not receive a new HSA Bank card; simply continue to use your existing card.

Be sure to present your new insurance card to your providers and pharmacy to avoid claims being denied.

Questions/Comments/Concerns

Things to Keep in Mind

If an individual has an HSA when he or she is ready to sign up for Medicare, they cannot contribute to the HSA. If an individual contributes to the HSA after Medicare coverage starts, he or she may have to pay a tax penalty. To avoid a tax penalty, six months prior to you turning 65 and signing up for Medicare, please notify Human Resources so 富二代视频app may stop the employer’s contribution.
Three months prior to you turning 65, you will need to sign up for Medicare Part A & B only.
- Link:
- DO NOT sign up for Medicare Part D, 富二代视频app’s supplement plan provides your Rx plan
One to two months prior to you turning 65, contact Human Resources to begin the process of transitioning to the Post-65 AmWins Retirement plan.
If you move, please be sure to keep Human Resources informed of any address changes.

If you need assistance, have questions or do not receive your new cards do not hesitate to reach out to: Brooke Baker, Benefits Administrator, 765.658.4135 or brookebaker@depauw.edu