ACT

Consider the following before you enroll.

Understand your benefit options

Complete the enrollment forms if you want to:

Enroll in, change, or drop your medical, dental, and/or vision coverage (if you elect anything other than single coverage; identify all eligible dependent(s) on the enrollment forms).

Need to Make a Change After Open Enrollment?
Once Open Enrollment ends, you may only make changes to your benefits for a Qualified Life Event (e.g., marriage, divorce, birth/adoption of a child, or loss of coverage). Otherwise, your next opportunity to make changes will be during the next Open Enrollment period, which will be held in the Fall of 2025 for coverage in 2026.

ENROLLMENT FORMS
Enrollment forms can be accessed directly from the website.
Download your enrollment forms below and sign up for 2025 coverage. The enrollment form includes your weekly contributions. Contact your Benefits Administrator, if you require assistance with accessing your enrollment form.

Review your enrollment materials and Summary of Benefits and Coverage (SBCs) on your benefits website.
Consider your benefit needs and compare your options for 2025.
Contact your Benefits Administrator if you have any questions.

Make your benefit decisions

Choose your benefits carefully.
Decide if you want to add or delete dependents from your coverage. If you’re adding a dependent, you are required to provide dependent documentation, such as a marriage certificate and/or a birth certificate.
Review your life insurance needs and update your beneficiary designation, if changes are necessary.
Review your LTD needs and update your tax election, if changes are necessary.

Take advantage of these special programs
Check out our special programs such as Transform Oncology, Transform Diabetes, Memorial Sloan Kettering (MSK) and more. They are designed to help you get great care and save money too.

Download your forms here and sign up for 2025 coverage.

Sign up for 2025 Medical, Dental or Vision Coverage Decide who will be covered. If needed, provide Marriage License and/or Child(ren) Birth Certificate(s).	Complete a benefit enrollment form.
Waive your ShopRite medical, dental, or vision coverage.	Check off the waiver option on the enrollment form. NOTE: If waiving medical, you must also complete and return the WAIVER OF HEALTH PLAN COVERAGE AND VERIFICATION OF OTHER HEALTH COVERAGE form.
Spousal Certification Form	Complete a spousal certification form if enrolling a spouse for the first time. Spouses are required to enroll in their employer's coverage as primary insurance if it's available to them.
Long Term Disability Benefits (LTD) - How do you want to receive your benefit?	Complete the LTD enrollment form.
Basic Life Insurance	Complete the basic life insurance enrollment form.

Take advantage of a different network option.

Take advantage of a second network offering that may help maximize your benefits and lower your costs. Aetna Whole Health is an ACO (Accountable Care Organization) Network. This is a group of healthcare providers that provide coordinated care to patient populations, including incentives to improve the quality of patient care and health outcomes while controlling costs.

How can I find out if my doctors are in the Broad Network?

How to search the ACO Network.

How to search the Broad Network.

Check out these helpful tools and resources:

Enrollment Guide: Download this detailed guide and learn more about specific benefits and services.
Frequently Asked Questions: Answers to the most frequently asked questions.
Summary of Benefits and Coverage: How the plan would share the cost for coverage services. See each of the benefit plans provided here for details.
- Basic Managed Choice Plan - ACO/Broad
- Managed Choice Plan - ACO/Broad
- HCRA Plan - ACO/Broad

Important Terms: Commonly used benefit terms and what they mean.
Legal Notices: Your rights as a consumer.

Once you have completed the forms, please submit them to your Benefits Administrator to receive the coverage of your choice in 2025. If you have any questions along the way, please contact your Benefits Administrator.

Jeff Baker
Benefits Administrator
1070 US Highway 46
Ledgewood, NJ 07852
jeff.baker@wakefern.com
973-927-8300 ext. 340

2025 For associates of ShopRite