How to Enroll in the MBO

New Hire/Qualifying Event

  • Step 2. Choose your benefit options:                
    • Existing Employee - Qualifying Event - If you are satisfied with your current plan, no other forms are needed other than the MBO Election form.  If you want to make changes to your medical plan elections you will need to complete the following forms (as applicable).
    • New Employee - Decide which plans you wish to enroll in.
      • FSA Enrollment Form- Required if you choose the Blue Shield Bronze PPO plan and wish to enroll in the FSA plan to receive your County match.
      • Life Insurance and AD&D Enrollment Form - Required if you wish to enroll your Spouse/Domestic Partner, dependent children or yourself in Supplemental Life and/or Accidental Death & Dismemberment Insurance.
  • Step 3. Submit your completed forms to your Payroll Specialist.

Open Enrollment

*If enrolled in or enrolling in the MBO open enrollment, changes cannot be made through EMACS self-service.  Forms below must be completed and returned to your Payroll Specialist.

  • Step 2. Choose your benefit options:
    • If you are satisfied with your current plan, no other forms are needed other than the MBO Election form.  If you want to make changes to your medical plan elections you will need to complete the following forms (as applicable).            
      • FSA Enrollment Form- Required if you choose the Blue Shield Bronze PPO plan and wish to enroll in the FSA plan to receive your County match.
      • Life Insurance and AD&D Enrollment Form - Required if you wish to enroll your Spouse/Domestic Partner, dependent children or yourself in Supplemental Life and/or Accidental Death & Dismemberment Insurance.  Or you wish to make any changes to coverage levels.
  • Step 3. Submit your completed forms to your Payroll Specialist.

How to Dis-enroll from the MBO

To dis-enroll in the MBO please complete the Modified Benefit Option (MBO) Election Form and submit to your Payroll Specialist: