Hidalgo ISD Benefits Enrollment System

Hidalgo ISD Benefits Enrollment System

Prepared exclusively for those who educate our future.
Username
Agent Passcode

Hidalgo ISD Benefits Enrollment System

Prepared exclusively for those who educate our future.
Enrollment ID
Employee Enrollment ID is their first letter of their last name, first letter of their first name, and their mm/dd/yy birthdate. For example: George Washington, born Feb. 22, 1732. His Enrollment ID would be WG022232
Name *
Date Of Birth *
Gender *
Employee Name
Employee SSN *
Email Address *
Dependent1
AGENTS: If you had to manually enter an employee's name and date of birth, please click this button to apply the district contribution of $390 to their monthly premium.

District contribution for manually entered employee Choose this option only for manually entered paraprofessionals
Employee Alt
Month
Day
ER Amt
EE Amt
Plan
Last Year Plan
Last Year Rate
Sex
Year

Hidalgo ISD Benefits Enrollment System

Prepared exclusively for those who educate our future.

Dependents

Hidalgo ISD Benefits Enrollment System

Prepared exclusively for those who educate our future.
Enrollment Summary:
{date}

{name},

Below is a summary of your medical benefits enrollment. Please keep a copy for your records.
Your selected plan is: {humanaBenefits}{trsActivecare}

You elected the following coverage: {coverageLevel}{trsCoverage}

Your monthly premium will be: ${monthlyPremium}
Acknowledgement and Signature *

My signature acknowledges that I am authorizing Hidalgo Independent School District to deduct equal amounts from my paychecks to collect the designated premium above. I recognize that these selections constitute a deliberate binding decision on my part that may not be changed until the enrollment period for the next plan year or if I experience a change in status not covered by law.
Employee Signature *

Clear
Date

Month Day Year
Date
Should be Empty:

Enrollment Summary: