Skip to main content
Everett Public Schools
Login

Loading...

Editing previous response:

Please fix the highlighted areas below before submitting.

Open Enrollment 2025 - Health Benefits Selection

EPS logo, wavy design in crimson and gold
HUMAN RESOURCES DEPARTMENT

This form should be used to submit all documentation for benefits selected in the 2025 open enrollment period
(April 28, 2025 - May 16, 2025) 

Key Information:
  • Beneficiary Changes: If you are making changes to your beneficiaries, please ensure you have gathered all necessary documentation prior to enrollment.

  • No Action: If you do not actively enroll during the open enrollment period, your current benefit coverage will remain the same for the upcoming plan year, with the exception of your FSA and HRA accounts. You must reenroll in your FSA and HRA accounts if you want to keep them active. It is always a good idea to sit with an advisor to go over all selections and beneficiary information. Benefit counselors will be available at schools and locations throughout the city during the enrollment period. See the schedule below for details.

  • Documentation: It is important that you submit all documentation to record your benefit election by using this form. If the appropriate documents are not submitted, there may be a delay in obtaining the appropriate benefits.
It is crucial to enroll or make changes within the designated open enrollment period, as changes outside of this timeframe are generally not permitted unless you experience a qualifying life event. Qualifying life events are listed in the first few pages of the Benefits Guide.


Remember to schedule a one-on-one meeting with a benefits counselor during the enrollment period. These sessions are the best way to ensure you fully understand your options and make the most informed decisions for yourself and your family. Take time to make the best decisions for you and your family during this important period.

If you have any questions, please contact the HR Department.

Required fields marked with an asterisk *

School/Location*
Answer Required
Which Health Benefit are you enrolling in?*
Answer Required
Please indicate whether your plan will be an HMO or PPO
Answer Required
Upload Attachment/JPEG*
Please attach appropriate enrollment forms.
Answer Required
or drag it here.
Upload Attachment/JPEG*
Please attach supporting documents (i.e. birth certificates, marriage certificates, etc.)
Answer Required
or drag it here.
Confirmation Email