New Employee Benefits Package
Documents & enrollment forms for new employees


As a new employee, you have 31 days from your effective date of hire (the first day worked) to enroll in a benefits package. Failure to elect coverage, including returning your completed enrollment forms during the enrollment period, may result in no coverage for a period of up to 12 months. The LBCC Benefits Eligibility Acknowledgement Form will give you an overview of all the Health and Welfare Benefits LBCC has to offer. For a complete listing of our benefits, please refer to the Employee Health & Welfare Benefits Guide.

Employees who do not meet this timeline must wait to enroll during the next open enrollment period.

Benefits Enrollment Packet

Anthem/Blue Cross, HMO Enrollment Form
Anthem/Blue Cross, PPO Enrollment Form
DeltaCare, HMO Enrollment Form
Delta Dental, PPO Enrollment Form
Domestic Partner Affidavit
Health Insurance Waiver of Benefits
Kaiser Permanente, HMO Enrollment Form
LBCC Group Term Life Insurance Enrollment Form

No enrollment form is needed for the mental health and vision benefits. Your enrollment is automatic unless you are declining all benefits or declining the dental, mental health and vision of which you’d need to complete the health declination form.  

Optional & Voluntary Plans

Section 125 Plans

Flexible Spending Accounts Enrollment Kit
Medical FSA Employee Handout
Dependent Care FSA Employee Handout
FSA Benefits Card Handout
FSA Mobile App
FSA Grace Period FAQ
FSA Guide


Evidence of Insurability Form
How to Enroll in Unum Voluntary Products
Unum Life and AD&D Insurance
Long Term Disability
Short Term Disability

Savings & Retirement Plans

Saving & Retirement Plans Year 2024