Long description for Personal Benefits Enrollment Statement Form page 1

The image contained in the July "How to read your Personal Benefits Enrollment Statement (PBES)" article is the first page of the Personal Benefits Enrollment Statement.

In the top left corner is the 2 week phase date. Below the phase date is your address box with a reminder to update you address in ERS OnLine. The center of the statement shows the plans you are currently enrolled it in and what you’ll pay if you don’t make any coverage changes. It displays up to three of your dependents that you currently cover. The bottom of the statement contains notes about ineligible dependents, new dependents, dispute of coverage, and a notice about insurance funding. They may not apply to most members but can be important to some.