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Benefits Enrollment 2026-2027

5 STAR Event Services provides a comprehensive benefits package to all regular, full-time employees. We recognize that benefits are a significant part of your total compensation and make every effort to ensure the plans available to you are plans that suit the needs of you, your family and dependents. Please check the Benefit Guide for additional information on changes to deductibles, co-pays, and prescription costs. Please look over the benefit documents carefully. YOU MAY ALSO DECLINE COVERAGE BY COMPLETING THE FORM. For additional information, please visit your benefits booklet. Please contact HR@5starstaff.com if you need further assistance.

Personal Information

Employee:

Social Security Number:

Date of Birth

Gender

Phone Number

Email Address

Address

Reason for Enrollment or Change

A
B
C
D
E
F
G
H
I
J

Explain Other:

Date of Qualifying Event

Benefit Enrollment:

MEDICAL BENEFITS:
Currently, our MEDICAL INSURANCE carrier is United Healthcare, an EPO policy. (EPO, meaning “exclusive provider organization,”) which just refers to staying within the plan’s network of select providers. If you get care outside the EPO network, you’ll likely have to pay the full cost of that visit. EPO insurance offers the freedom to see any network provider without a referral and doesn’t make you choose a primary care provider (PCP).

MEDICAL Elections (Cost to Employee PER Pay Period)

A
B
C
D
E
DENTAL & VISION BENEFITS:
Our DENTAL & VISION INSURANCE is provided through MetLife. You may choose any provider, however, using providers in the network should lower your out-of-pocket expenses. A list of in-network doctors may be accessed at www.metlife.com. A summary of the dental and vision benefits is provided in your benefit booklet.

DENTAL Elections (Cost to Employee PER Pay Period)

A
B
C
D
E

VISION Elections (Cost to Employee PER Pay Period)

A
B
C
D
E

Dependent Information

Name (1)

Relationship (1)

Gender (1)

Date of Birth (1)

Social Security Number (1)

Life & Accidental Death and Dismemberment (AD&D) Insurance

MetLife Life and AD&D insurance help support your financial security—especially if you or your loved ones rely on each other for financial support. Please designate at least one beneficiary below. If no beneficiary is selected, 5 STAR Event Services will be designated as your default beneficiary.

Primary Beneficiary Name (1)

Relationship

Date of Birth

Social Security Number

Phone

Address

Email

Would you like to add another beneficiary?

A
B

Secondary Beneficiary Name (2)

The beneficiary is

A
B

What % level should this beneficiary receive?

Relationship (2)

Any additional comments?

Agreement

Authorization

Signature

Signature