Office of Human Resources home faculty/staff new employees retirees work @ Le Moyne Retirement Checklist Name* (Anticipated) Retirement Date Employee BenefitsPlease check the insurance coverage that you are interested in carrying upon retirement. Health Insurance*(pre-65) HealthyBlue - Individual(pre-65) HealthyBlue - Employee/Spouse(pre-65) PPO-J - Individual(pre-65) PPO-J - Employee/Spouse(post-65) Aetna - Individual (self)(post-65) Aetna - Individual (spouse)I will complete a waiver of health insurance Dental Insurance*Delta Dental - Individual (self)Delta Dental - Individual (spouse)I will complete a waiver of dental insurance Social Security & Medicare InformationPlease review the information provided on the Social Security Administration website in regards to your benefits. If you are at least 65 years old you should already be enrolled in Part A (hospital insurance), and prior to your retirement date you should enroll in Part B (medical insurance). Please review the Medicare website. If you are enrolling in the College Aetna Medicare Advantage plan you do not have to enroll in Part D. Social Security Medicare #: Part A Effective Part B Effective Life InsuranceEmployer paid Group Life Insurance will terminate upon your retirement date. You will be eligible to convert or port your policy to an individual policy. Please see the link below for more information: Conversion vs. Portability You will be receiving a Notice of Coverage Continuation from the Office of Human Resources. Employer paid Long-term Disability Your employer paid Long-term Disability will terminate upon your retirement date. Flexible Spending AccountYour Flexible Spending Account will terminate upon your retirement date. You will have 90 days after that date to submit claims for reimbursement. Reimbursement Form Dependent Care Reimbursement Form Voluntary Term Life & AD&D InsuranceIf you have Voluntary Term Life & AD&D Insurance your insurance will terminate upon your retirement date. AFLAC Cancer or Personal Accident InsuranceIf you have an AFLAC Cancer and/or Personal Accident Insurance policy, you will have the option to continuing your coverage with AFLAC. You will be contacted by an AFLAC representative with information regarding how to continue your coverage. Questions/Comments Submit * Required