Waiver of Insurance Coverage

If you have medical, vision and dental insurance provided from elsewhere, you may elect to waive Lawrence Tech's coverage.   In lieu of this coverage, you will be paid opt-out cash.  There are two plan options to opt-out of coverage as follows:  

Plan 1 = Medical opt-out pays $25.00 per pay period

Plan 2 = Medical, dental and vision opt-out pays $30.00 per pay period

If you choose Plan 1, you opt out of medical insurance coverage only, however you may enroll in the dental and vision plans.  If you choose Plan 2, you opt out of medical, dental and vision coverage.  Both plan options are taxable benefits and subject to FICA, Federal, state and city taxes.  The amount deducted for taxes depends on individual circumstances.  Calculations will not be provided prior to actual payment.

Employees who terminate employment during the year will forteit any remaining waiver fee.

To enroll in either plan:

• Complete the Waiver of Insurance Coverage Form.
• Show proof of other insurance by providing a copy of an insurance I.D. card.  Note: Canadian citizens covered by OHIP are also required to show proof of insurance.
• Submit both documents to the Office of Human Resources.

If during the plan year you lose your other medical, dental and vision insurance and you want to establish coverage through Lawrence Tech, a special enrollment period may allow you to enroll yourself and/or your dependents in the plan.  However, you must request enrollment within 30 days after your other coverage ends or after the employer stops contributing towards the other coverage.  You must complete the appropriate benefit forms and return them to the Office of Human Resources within 30 days of loss of coverage.  You will be required to provide proof of loss of coverage.