Authorization For Cancellation Of Voluntary Deductions

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Anne Arundel County Public Schools | Division of Human Resources | Benefits Office
Authorization for Cancellation of Voluntary Deductions
Place a check mark to the left of the item to be cancelled. Write
Deduction
Amount
See Note
in the current amount of the deduction to be cancelled. When
Dues
completed, please return form to: Anne Arundel County Public
AEL Dues
Schools • HR/Benefits, 2644 Riva Road, Annapolis, MD 21401.
AFSCME-AFL/CIO Dues
Note 1
The effective date is subject to the date of the receipt of this
SAAAAC Dues
Note 6
form in the HR/Benefits Office and the cut-off date of work to
be entered for payroll processing.
TAAAC Dues
Note 4c
Insurance
Notes
AFSCME Insurance
Note 2
1
AFSCME dues may be cancelled only during certain time
Cigna Voluntary Insurance
periods. Refer to Article 2, Section 2 of the negotiated
agreement, or contact your union representative.
Educators Insurance
Note 3
2
To cancel an AFSCME Sponsored Insurance Plan, contact
Employee Plan Services (EPS) Insurance
Note 4a
Jeff Patti
Horace Mann Insurance — Income
7400 York Rd, Suite 201, Baltimore, MD 21204
Horace Mann Insurance — Life
800-876-7768.
NEA Insurance
Note 5
3
Employee should contact the following directly, who will
Unum Long-Term Care Insurance
notify HR/Benefits to terminate deductions.
Savings
State Employees Credit Union (SECU)
College Savings
2661 Riva Road
or
8684 Veterans Highway,
Credit Union Savings
Note 3
Suite 100
(across from BOE)
Building 700
Millersville, MD 21108
All Other Savings Accounts
410-923-4300
Annapolis, MD 21401
U.S. Savings Bonds
410-573-7780
Supplemental Retirement Plans
Educators Financial Group, LLC
10400 Little Patuxent Parkway, Suite 210
ING
Cancel or change your deductions online,
Columbia, MD 21044
with Retirement Manager, located at:
443-279-0277 or 800-265-8787 | 410-823-4144 (fax)
Lincoln National
Supplemental Retirement.
Met Life Resources
Click “Engage” and click the link for
4
a. To cancel your TAAAC, AEL, or SAAAAC-sponsored EPS
VALIC
“Online Retirement Manager”
insurance, contact EPS at the number below.
Cancellation requests will not be taken from this form.
Other
Employee Plan Services (EPS-AFLAC, Hartford)
Fund for Children & Public Education
Note 4b
7100 Baltimore Avenue, #502
United Way Charity
College Park, MD 20740
Employee Name (Print)
301-985-2020 or 877-884-3784
b. To cancel your Fund for Children & Public Education
Signature
Date
deduction, contact TAAAC at 410-224-3330.
c. TAAAC sponsored insurance is conditional upon
Social Security Number
Cancellation
membership in TAAAC. Cancellation of TAAAC dues
Effective
requires cancellation of TAAAC sponsored insurance.
Date
Such cancellation can only be made in writing to
Location/School
TAAAC between August 15
th
and September 1
st
. If
you decide to pay your own dues directly to TAAAC,
Comments
have TAAAC notify HR/Benefits so that the TAAAC
insurance may be continued.
5
To stop TAAAC-sponsored NEA deductions, contact
BCL Systems (3
rd
party administrator) at 1-888-805-3915.
6
SAAAAC dues may be cancelled only during certain time
periods. Refer to Article 3, Section 3.10 of the negotiated
agreement, or contact your union representative.
Healthcare Deductions
To be completed by Human Resources/Benefits
Healthcare coverage (medical, dental, or vision) may only be
Entered By
Audited By
changed or cancelled during open enrollment or when there is
an approved lifestyle change and the change is made within 31
days of the event. For more information, contact HR/Benefits
Effective Date
at 410-222-5219/5221. To obtain a required Lifestyle Change
Form, go to aacps.org>Human Resources>Forms.
AACPS • Division of Human Resources • Benefits Office • DPS/SG • 2050/7 (Rev. 10/12)

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