INSTRUCTIONS: ALABAMA NEW EMPLOYEE — OPEN ENROLLMENT SALARY REDUCTION AGREEMENT DEPENDENT PREMIUM CONVERSION PLAN (Form IB08)
Alabama state employees use form IB08 to enroll in or opt out of the Dependent Premium Conversion Plan during period of Open Enrollment only. This document can be obtained from the website maintained by the Alabama State Employees' Insurance Board.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 1: Enter your name in the first blank box.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 2: Enter your Social Security number in the second blank box.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 3: Enter your street address in the third blank box.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 4: Enter your city, state and zip code in the fourth blank box.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 5: Enter your work telephone number, including the area code, in the fifth blank box.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 6: Enter your home telephone number, including the area code, in the sixth blank box.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 7: Place a check mark next to the first statement if you are electing to enroll in the Dependent Premium Conversion Plan and authorize Alabama to redirect part of your salary to pay premiums with pretax dollars for dependent premiums.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 8: Place a check mark next to the second statement if you are not electing to enroll in the Dependent Premium Conversion Plan.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 9: Enter your signature on the next blank line.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 10: Enter the date on the last blank line.
Alabama New Employee — Open Enrollment Salary Reduction Agreement Dependent Premium Conversion Plan IB08 Step 11: Mail the form to the address given at the bottom of the page.
