NSG Benefit Selection

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nsg benefit selection

Start your NSG Benefit Selection by filling out the form below.

NSG BENEFIT SELECTION

If you have any questions regarding this form or selection, please contact Lisa A. Geiken at (308) 537-7191 or email at LisaA.Geiken@nsgco.com.

First Name^*

Email^*

Last Name^*

If you would like to keep Enrollment the same as previous year, please select "No Change" and submit form. If you would like to make changes, please select "Make Change" and complete the form below.^*

No ChangeMake Change

Base HDHP (High Deductible)

Employee Only - $0.00/wkEE & Spouse - $80.94/wkEE & Child(ren) - $61.59/wkEE & Family - $121.13/wk

Mid (Basic)

Employee Only - $44.45/wkEE & Spouse - $156.49/wkEE & Child(ren) - $116.95/wkEE & Family - $228.98/wk

Buy Up (Basic)

Employee Only - $73.36/wkEE & Spouse - $222.98/wkEE & Child(ren) - $168.99/wkEE & Family - $318.60/wk

Voluntary PPO Dental Insurance (Basic)

Employee Only - $8.48/wkEE & Spouse - $16.88/wkEE & Child(ren) - $20.96/wkFamily - $31.79/wk

Voluntary PPO Dental Insurance (Buy Up)

Employee Only - $11.55/wkEE & Spouse - $23.07/wkEE & Child(ren) - $29.24/wkFamily - $44.22/wk

Voluntary Vision Insurance

Employee Only - $1.54/wkEE & Spouse - $2.93/wkEE & Child(ren) - $3.43/wkFamily - $4.82/wk

Additional Voluntary Life and AD&D

Yes - see Benefits Guide for weekly premium (Lisa A. will reach out for beneficiary information)No

Voluntary Short-Term Disability

Yes - see Benefits Guide for weekly premiumNo

Voluntary Long-Term Disability

Yes - see Benefits Guide for weekly premiumNo

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