Web-based "Health/Benefit Enrollment" (eBenefits)

Exchange Employee Management and Pay System

eBENEFITS(2)

Web-based "Health/Benefit Enrollment" (eBenefits)

OMB: 0702-0139

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0702-0139 can be found here:

Document [pdf]

Download: pdf | pdf

EXCHANGE-

eBenefits

ARMY & AIR FORCE EXCHANGE SERVICE

OMB NO. 0702OMB approval expires
MMM DD, YYYY

Welcome to eBenefits, your online benefits enrollment system.

Returning Users
If you already have a password and are ready to login, please read the Agency Disclosure Notice and the Privacy Act Statement. Then enter
your User ID (TSSID or AF#) and your password and select [Login]

New Users of New
Passwords
If this is your first time
visiting the site or you have
forgotten your password,
you should create or
reset your password.
This eBenefits system has
been tested with Internet
Explorer 6.0 and higher
and Mozilla Firefox 2.0 and
higher with JavaScript and
cookies enabled.
Exchange eBenefits is a
secure site.

Your User ID:

Your Password:

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense,
Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA
22350-3100 (0702-XXXX). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to
comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.
Responses should be sent to your local Exchange HR Representative or to the Treasury Benefit department at the Army and Air Force Exchange Service, 3911
South Walton Walker Blvd., Dallas, TX 75236-1598.

PRIVACY ACT STATEMENT
AUTHORITY: Title 10 U.S.C. 3013, “Secretary of the Army”; Title 10 U.S.C. 8013, “Secretary of the Air Force”; Title 42 U.S.C. 659, “Consent by United States
to income withholding, garnishment, and similar proceeding for enforcement of child support and alimony obligations”; 31 CFR 285.11, “Administrative Wage
Garnishment”; DoD Directive 7000.14-R, Volume 13 and 16, “DoD Financial Management Regulation”; Department of Defense Instruction (DoDI) 1400.25,
Volume 1408, “DoD Civilian Personnel Management System: Insurances and Annuities for Nonappropriated Fund (NAF) Employees”; Army Regulation 2158/AFI 34-211(I), “Army and Air Force Exchange Service Operations”; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): Information collected is to provide the basis for computing civilian/retiree/survivor pay deductions and for processing of insurance

benefits chosen by active Exchange associates.

ROUTINE USE(S): Your records may be disclosed outside of DoD pursuant to Title 5 U.S.C. §552a(b)(3) regarding DoD “Blanket Routine Uses” published at

http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx. Information may be disclosed to former spouses and/or survivors, to federal, state, or
local child support agencies for purposes of assisting the agencies in the discharge of their responsibilities under federal and state law.
DISCLOSURE: Voluntary, however, failure to provide all the requested information may result in the denial of your application for benefits.
SYSTEM OF RECORD NOTICE: AAFES 0703.07 “Employee Pay System Records”;

http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570129/aafes-070307.aspx
AAFES 0903.06 “Personnel Management Information System”;

http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570130/aafes-090306.aspx

This site provides eligible Exchange associates and their eligible family members the capability to manage their benefit enrollments.
The information contained herein falls under the purview of the Privacy Act of 1974 and will be safeguarded in accordance with the
applicable system of records notices listed above.
PROVIDING INFORMATION FOR YOUR HEALTH CARE COVERAGE

If you are changing your plan during the annual open enrollment period or for a family life change event, please be certain to read your
Benefits summary before making any new changes. All newly hired or newly eligible individuals will be provided detailed information on
benefit choices from their local Human Resource Manager.
Please be prepared to have all information available to complete each section of the enrollment. This may include dependents and
beneficiaries names, dates-of-birth, Social Security Numbers, addresses, and Trust names. If you choose to set up pretax accounts for
Health Care or Dependent Care you will be required to put an annual dollar amount to be deducted equally from each of your 24 pay
checks.

Directions are enclosed with each area of the health enrollment process. You will also be provided a benefit calculator which will inform
you of your total paycheck deductions after you make each choice. You will have the option of changing any choices prior to submitting
the final enrollment plan.
Should you have any questions or issues completing this enrollment, please contact your local HRM or call the Exchange’s Human
Resource Support Center at 800-508-8466.

D
RA
FT

Exchange Benefits
Home |

Welcome
Personal Information
Section 125
Dependents
Benefits
Beneficiaries

Begin Your Open Enrollment Elections Now!
Your current benefit elections will continue to the New Year except for the Flexible Spending Accounts
(FSA). You must make new FSA elections each year. All elections are saved as they are made. If you
would like to enroll in a benefit plan(s), or would like to make changes, begin by following the six step
process identified below. Your final benefit elections must be submitted by the end of the Open
Enrollment period 11/30/2015. You can return to this site to make changes any time before this date. At
the close of the Open Enrollment period your elections will be final and cannot be changed until the next
Open Enrollment period or if you experience a qualified life event during the year, such as a marriage or a
birth.

6 Easy Steps

Welcome to eBenefits—your online benefits enrollment system!
eBenefits has been designed to help you:

Learn about valuable benefit plans available to you as a member of the Exchange family
Compare benefit options

Make benefit elections for you and your dependents

Before you complete your enrollment, we suggest you discuss your benefits decisions with your spouse
and/or other family members. And, on each eBenefits screen, you will find links to helpful information
about the plans. Once you complete the following 5-step process, your benefits enrollment will be
complete! It's that easy!

Step 1:

Review Your Personal Information

Review your current name and address on file.

Step 2:

Add or Change Dependent Information

Add, edit or review your dependent information.

Step 3:

Choose Your Benefit Plans

Make elections for your benefits. Your changes will be saved as you enter them.

Step 4:

Name or Change Your Beneficiaries

Enter or Update the information about your beneficiaries for each of the Plans you are
enrolled.

Step 5:

Review Your Enrollment Confirmation

Review your new elections, dependents and beneficiary information on the Enrollment
Confirmation page. If you want to make changes,use the links on the left menu and then
return to the Enrollment Confirmation.

Step 6:

Print a copy for your records

Begin

https://exchangebenefits.ehr.com/ESS/Health/Elect/Welcome.aspx[11/30/2015 1:08:57 PM]

Logout

Enrollment Tips
Your latest enrollment
decisions will be accepted
as your final elections
decision.
To review or change your
dependent and/or
beneficiary information,
click on the links in the left
menu.

RA
FT

Enrollment Confirmation

My Messages |

You can view your
enrollment summary at
any time.
Print a copy of your
enrollment summary for
your records.
Remember, you can make
changes at any time up
until 11:59 PM Central
Time on 11/30/2015.

D
RA
FT

Exchange Benefits
Home |

Welcome
Personal Information
Section 125
Dependents
Benefits
Beneficiaries

Add Beneficiary
Select Beneficiary Type and enter your beneficiary's information.
If you decide you do not wish to add a beneficiary, click [Cancel]. When you are finished, click [Save].
The form must be error-free before you will be allowed to leave this page.
Individual

Trust/Charity

Estate

RA
FT

Enrollment Confirmation

My Messages |

Cancel Save

https://exchangebenefits.ehr.com/ESS/Health/Elect/Beneficiary.aspx?Edit=-1[11/30/2015 1:37:53 PM]

Logout

Exchange Benefits
Home |

Welcome
Personal Information
Section 125
Dependents
Benefits
Beneficiaries

Logout

Trust/Charity

Estate

RA
FT

Enrollment Confirmation

My Messages |

Enter your beneficiary's information in the form below.

Note: Adding beneficiaries to a plan does not mean you are enrolled in that plan.

If you would like to list a dependent you have on file as your beneficiary, select that dependent's name from the dropdown list below. Your
dependent's information will be pre-filled. Complete the entry by filling in the missing information.
Select "New Person" or a dependent on file
New
Person
New Person

First Name:
Last Name:
SSN:

Date of Birth:
Relationship:
Country:

Use my home address for this beneficiary

Address 1:
Address 2:
City:

State:
ZIP:

Phone Number:

Cancel Save

https://exchangebenefits.ehr.com/ESS/Health/Elect/Beneficiary.aspx?Edit=-1[11/30/2015 1:38:20 PM]

Exchange Benefits
Home |

Welcome
Personal Information
Section 125
Dependents
Benefits
Beneficiaries

Logout

Trust/Charity

Estate

RA
FT

Enrollment Confirmation

My Messages |

When entering a trust,show the exact name of the trust, date of the trust agreement, the name of the trustee, and the Tax Id Number of the
trust in the boxes provided.

Trust Information:

Tax ID:

Cancel Save

https://exchangebenefits.ehr.com/ESS/Health/Elect/Beneficiary.aspx?Edit=-1[11/30/2015 1:39:07 PM]

Exchange Benefits
Home |

Welcome
Personal Information
Section 125
Dependents
Benefits
Beneficiaries

Trust/Charity

Estate

RA
FT

Enrollment Confirmation

My Messages |

Enter your estate information in the form below.

Estate Name:

Cancel Save

https://exchangebenefits.ehr.com/ESS/Health/Elect/Beneficiary.aspx?Edit=-1[11/30/2015 1:39:31 PM]

Logout

D
RA
FT

File Type	application/pdf
File Modified	2016-06-17
File Created	2016-01-26