Employee Benefits - Forms

PDF DocumentINSURANCE PLAN SUMMARIES

  1. Administrative Assistants (Secretaries)
  2. Administrators
  3. Maintenance
  4. Paraprofessionals
  5. Teachers

HEALTH COVERAGE INFORMATION - BLUE CROSS:
PDF DocumentChange of Status
PDF DocumentEmployee Enrollment Form

DENTAL COVERAGE INFORMATION - ADN:
PDF DocumentPlan Information
PDF DocumentEnrollment/Change Form

PRESCRIPTION COVERAGE INFORMATION - MEDTIPSTER:
PDF DocumentClaim Form - Prescription Form

VISION COVERAGE INFORMATION:
PDF DocumentOptical Enrollment/Change Form

LIFE INSURANCE COVERAGE INFORMATION - MADISON NATIONAL:
PDF DocumentChange of Beneficiary Form 
PDF DocumentEnrollment Form

LIFE & DISABILITY COVERAGE (Voluntary Self Pay) - SET SEG:
PDF DocumentLife Insurance Information
PDF DocumentDisability Insurance Information

VOLUNTARY BENEFITS - Trustmark
PDF DocumentContact Information

FLEXIBLE SPENDING ACCOUNT INFORMATION - Employee Benefits Concepts:
External Linkhttps://www.ebcflex.com 
PDF DocumentChange of Status Information/Form
PDF DocumentDependent Care Information
PDF Document‚Äč FSA Dep Care Claim Form
PDF Document FSA Medical Claim Form
PDF DocumentFSA Qualifying Expenses
PDF DocumentUnreimbursed Medical Care Information
PDF Document$500 Carry Forward Provision

Board of Education 639 Oak Street Wyandotte, MI 48192 734-759-6002
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