Newly Appointed Trainees and Affiliates: Information to Assist You with Your Enrollment
This section of the web site contains links to the following information to guide you through the enrollment process:
- New Hire Enrollment Instructions – Please print this document to assist you in completing the Enrollment Form while online. The Enrollment Instructions provide detailed information regarding completion of each section of the form.
- Enrollment Form Login – The enrollment form must be completed by all Trainees and Affiliates for initial enrollment in your selected plans. Please complete the enrollment form to do the following:
- To enroll yourself and eligible dependents
- To waive coverage for your eligible dependents
- To complete the life insurance beneficiary information
Please note: If you do not enroll yourself or your eligible dependents within the 31-day initial period of eligibility, neither you nor your dependents will be eligible for enrollment in these plans until the next open enrollment period for the following plan year, unless there is a qualifying ‘life’ event. Your 31-day initial period of eligibility begins with your appointment start date in Section 1 of the Enrollment Form.
The Enrollment Form is a secure document, and in order to initially access the form you will need your 1) City of Hope Employee ID Number and 2) date of birth. When you click on New Hire Enrollment Form Login, you will be prompted to enter this information in the spaces provided. Once you have entered the information, click Login and you will be prompted to create your own unique password. Please keep a note of this password for future visits to this web site. Once you create your unique password, you will be taken to your pre-populated enrollment form. If you are unable to access the form with your City of Hope Employee ID number and date of birth, please call us immediately for assistance at the number listed below.
An ID card will be mailed to your home subsequent to your enrollment if you enroll in the medical, dental, and/or vision plans.
2017 Monthly Rates and Contributions: This document details the monthly premiums that will be charged by the insurance carrier for each line of coverage for Plan Year 2016, as well as displays the premium contributions paid by the City of Hope and any contributions paid by the Trainee or Affiliate.
Affidavit of Spousal Equivalency – You must submit this form at the time of enrollment into the plans if you enroll your eligible same-sex, or opposite-sex, Domestic Partner in the program. Please print the form, complete the required sections and signatures, and have it executed by a Notary Public. You may either scan and e-mail the document to COHBP@Garnett-Powers.com, or fax to the attention of City of Hope Plan Services at 949-215-2275. A copy of your form will be kept at Garnett-Powers & Associates.
Insurance Carrier Privacy Notice – This notice provides information regarding how the insurance carriers providing benefits and coverage through this program will handle any Personal Health Information. You must click Yes on the enrollment form that you have been provided this document.
COBRA Notification – This document contains important information regarding the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) pertaining to your enrollment in the City of Hope Trainee and Affiliate Benefit Program. The General Notice of COBRA Continuation Coverage Rights contains language that assumes you have already enrolled in the plan(s), and is included as a section of the enrollment form.
You must click Yes on the enrollment form, agreeing that you have read and understand this document, to allow you to submit and print your Enrollment Form. If you are enrolling an adult dependent, when you click Yes, you are confirming that this person has also read and understands the COBRA information included in this document. If you waive coverage for yourself, this document does not pertain to you.
Radiation Therapy Students
Radiation Therapy students are automatically enrolled in the Aetna Medical HMO and Aetna Dental DHMO plans and no further action is required. If you have any questions, please contact Garnett-Powers & Associates at the contact information below.
Garnett-Powers & Associates, Inc. is pleased to offer a City of Hope Customer Service Representative, dedicated to this program. Please address benefit and enrollment questions to:
Garnett-Powers & Associates, Inc.
23361 Madero, Suite 240
Mission Viejo, CA 92691
Or call us Monday - Friday, 8 am - 5 pm Pacific Time
Toll free at 1-800-261-7109
Contact City of Hope Program Services
We thank you for the opportunity to be of service to you and your family.
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Program and benefit information contained on this site has been deemed reliable, but can change without notice.