2026-2027 Group Election Form

  • Annual Employee Benefits Group Election Form (FY2026-2027)

    The Group Election Form indicates the benefits your City/Town offers to employees through MMIA during FY 2026-2027.  These selections are effective July 1, 2026.

  • Once this form is submitted, you will receive a copy for your records and MMIA receives a copy. If you determine there is an error, you must contact Nikki to have your submission removed and you can re-enter the group election for your City/Town. If there are changes in your benefits offerings you may receive a call to confirm. After April 16, 2026, the submission is final.

  • Click on each option below if you would like more information about the MMIA Employee Benefits current offings:

  • Medical
  • Dental
  • Vision
  • Basic Life and AD&D
  • Voluntary Life and AD&D
  • Elected Officials (sample resolution)

  • Annual Employee Benefits Group Election Form

  • WARNING!

    {citytown} currently offers benefits to elected officials.  We do not have an Elected Official Resolution on file.  Please upload a signed resolution when prompted to avoid an eligibility issue for your elected officials where claims are not being paid.  You can find a sample resolution by clicking on this Elected Official Resolution link.

     

  • It may take several seconds for the information to populate the fields below.

     

  • City/Town Mailing Address:

    {mailingAddress}

    {city}, {state}, {zip}

    Phone: {phone}     Tax ID#{taxId}

  • Please verify:*

  • Please correct/update any of the pre-filled information below by replacing the existing data with the current information.

  • The Benefits Administrator is the person who receives and completes the online enrollment, termination, and change forms. The email address below also receives the group election details once this form is submitted.
     

  • If the contact listed below is incorrect, please delete the information and replace it with the correct contact.

  • The Employee Benefit Billing Contact is the person who receives the monthly EB invoice via electronic delivery.

  • If the contact listed below is incorrect, please delete the information and replace it with the correct contact.

  • Annual Employee Benefits Group Election Form

  • {citytown} - {group} {typeA679}

  • MMIA is introducing a new medical plan for the 2026–2027 plan year. If you currently offer (or choose to offer) the Menu option to employees, the Pintler plan will automatically be included.

     
  • Current Medical Options
    {formMedical}

  • Menu (Bridger, Madison, Pintler (new) & HDHP) - Plan selections for your employees can be restricted via your personnel policy.

  • placeholder

  • 26/27 Individual Plans*

  • select all that apply

     

  • City of Kalispell Medical Plan options

     

  • placeholder

     
  • 26/27 Individual Plans*

  • select all that apply

  • Current Dental Option
    {dental466}
  • 26/27 Dental Election*
  • Current Orthodontia Benefit (Optional)
    {orthodontia}

    The orthodontia option applies to all participants.
  • 26/27 Orthodontia Benefit*

  • When adding this benefit, at least 80% of eligible employees must add this coverage during the open enrollment period.

     
  • Current Vision Option
    {vision}
     
  • 26/27 Vision Election*

  • When adding this benefit, at least 80% of eligible employees must add this coverage during the open enrollment period.

  • In your enrollment process, are employees required to choose the same coverage level (e.g., employee only, or family) for medical, dental, and vision plans, or can they select different levels for each?

  • Currently the {citytown} {bundleBenefits711} benefits for employees.

  • *

  • Basic Life Insurance & AD&D (The City/Town pays this premium for all eligible active employees)

  • Basic Life & AD&D Volume
    {basicLife469}
  • Basic Dependent Life Volume
    {basicDependent451}
  • Basic Dependent Life (if offered) covers an employee's spouse and/or dependent child(ren) up to age 26.

  • Voluntary Life and AD&D (The employee pays for this coverage, premiums are age-based)

  • Voluntary Life
    {voluntaryLife473}
  • 26/27 Voluntary Life*

  • Annual Employee Benefits Group Election Form

  • {citytown} - {group} {typeA679}

  • Please refer to your employee handbook or city employee policy to answer the following questions:
  • For variable hour employees, which method will you use to determine eligibility to comply with ACA requirements?*

  • Keep in mind the coverage period at the end of the look-back and administrative period must be equal to the look-back period.

  • Your current waiting period is:  {currentWaiting}

  • The waiting period is the time between when an employee becomes eligible for benefits (either as a new hire or after meeting the required minimum hours) and when those benefits become active. According to ACA rules, this waiting period cannot exceed 90 days from the initial eligibility date. Since monthly premiums for benefits are not pro-rated for partial months, it's recommended to align your personnel policy with specifics, such as starting benefits on the 1st of the month following the hire date or the 1st of the month after 30 days. It's crucial to ensure that the waiting period aligns with, or at least does not conflict with, the details outlined in your personnel policy.

  • Benefits must be offered to employees working at least 30 hrs/wk, according to ACA rules.  Your answer above must be 30 or less.

  • *ERROR!*

    Benefits must be offered to employees working at least 30 hrs/wk.

    Your answer above must be 30 or less.

     

  • Starting with the 26/27 Plan year, the amount a city/town contributs to employee's benefits must be reported in dollars rather than as a percentage.  If you need assistance with converting % to dollars, please contact Nikki.

    How much does the {citytown} contribute (pay) each month on behalf of:

  • Does your City/Town prorate the contribution for employees working less than full time?*
  • Does your City/Town pay a cash amount to employees that waive out of the medical plan?*
  • Does your City/Town allow elected/appointed officials and contracted executive positions to become eligible for benefits?*
  • Current Elected Official Coverage:  
    {validElected}
  • Browse Files
    Cancelof

  • A valid Elected Official Resolution is not currently on file with the MMIA Employee Benefits group.  This form required if you choose to allow elected officials to participate regardless if any choose to enroll.  Download a sample resolution.

  • When you click on the "Submit" button you will receive an email with a pdf attachment listing all of the elections selected for the upcoming plan year.

  • **You must correct the Hours/wk statement above before you can submit this group election form.  Remember, benefits must be offered to any employee that works at least 30 hours per week.**

  • Only one submission per City/Town is allowed.  If you determine there is an error after completing your form, please contact Nikki Willoughby nwilloughby@mmia.net to clear the prior entry so a new one can be completed.

  • Submission Date for email
     - -
  • Should be Empty: