Home Page
Online Enrollment
Rankin County School District – MetLife Cancer Enrollment
About Us
Contact Us
Search
Menu
Rankin County School District - MetLife Cancer
1) Plan Info
Plan Type
*
Add (Enroll)
Terminate
Change (change coverage or name)
Plan Name
*
Group Name
*
Group Number
*
Effective Date
*
2) Member Information
First Name
*
Middle Initial
Last Name
*
Gender
M
F
Social Security Number
*
Date of Birth (mm/dd/yyyy)
*
Email
Address
*
Address
Address
Address
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
U.S. Citizen
*
Yes
No
Contact Number
*
3) Plan Selection including Optional Elections/Riders
Variable Benefit Elections
Benefit
Option 1
Option 2
Option 3
Hospital Confinement
$100 per day
$100 per day
$100 per day
Surgical
up to $3,000
up to $4,500
up to $4,500
Radiation/Chemotherapy
$5,000 per month
$5,000 per month
$5,000 per month
Cancer or Specified Disease Diagnosis
$2,500
$5,000
$10,000
Colony Stimulating Factors
$4,000 per month
$4,000 per month
$4,000 per month
Wellness
$100 per year
$100 per year
$100 per year
Plan ( Required: You must select a plan option )
*
Select Plan
Option 1 - Employee ($24.01)
Option 1 - Employee + Spouse ($48.04)
Option 1 - Employee + Child(ren) ($33.59)
Option 1 - Employee + Family ($57.62)
Option 2 - Employee ($27.71)
Option 2 - Employee + Spouse ($55.39)
Option 2 - Employee + Children ($44.95)
Option 2 - Employee + Family ($65.92)
Option 3 - Employee ($33.06)
Option 3 - Employee + Spouse ($65.92)
Option 3 - Employee + Children ($44.95)
Option 3 - Employee + Family ($77.80)
Optional Intesive Care Rider
Option 1 - $325 per day
Option 2 - $625 per day
Option 3 - $825 per day
Select Rider Option
Employee - Option 1 ( $2.33 )
Employee + Spouse - Option 1 ( $4.97 )
Employee + Child(ren) - Option 1 ( $3.88 )
Family - Option 1 ( $6.52 )
Employee - Option 2 ( $4.47 )
Employee + Spouse - Option 2 ( $9.56 )
Employee + Child(ren) - Option 2 ( $7.45)
Family - Option 2 ( $12.54 )
Employee - Option 3 ( $5.90 )
Employee + Spouse - Option 4 ( $12.62)
Employee + Child(ren) - Option 2 ( $9.84)
Family - Option 3 ( $16.56 )
4) Add Dependents (Spouse and/or Children)
Action
Select Option
Add
Terminate
Change
Last Name, First Name, MI
*
Gender
Select Option
Male
Female
Dependent Social Security Number:
*
Email
Date of Birth (mm/dd/yyyy)
*
Relationship
*
Husband
Wife
Son/Stepson
Daughter/Stepdaughter
Other
Relationship
Child Handicap Status
Yes
No
Age when Handicap began:
Add
Remove
Signature Block
Your Signature (Type It)
Clear
Date Signed
Submit
If you are human, leave this field blank.
Need Assistance?
Call (601) 957-3737
Plan Information
MetLife Cancer – Rankin Co Schools (PDF)
Scroll to top