Fringe Benefits-Employee Forms

INSURANCE PLAN SUMMARIES

• Administrative Assistants (Secretaries)(PDF) (17PP, 2.68MB) (About PDF)
• Administrators & Central Office (PDF) (17PP, 5.43MB)
• Maintenance (PDF)(17PP, 6.51MB)
• Paraprofessionals (PDF) (17PP, 4.85MB)
• Teachers (PDF) (17PP, 1.76MB)

HEALTH COVERAGE INFORMATION - BLUE CROSS:

• Affordable Care Act 
• Change of Status(PDF) (1PP, 571KB)
• Employee Enrollment Form (PDF)(1PP, 602KB)
• Health Savings Account (HSA) Enrollment Form)(PDF) (1PP, 265.51KB)

DENTAL COVERAGE INFORMATION - ADN:

• Plan Information(PDF)(20PP, 6235KB)
• Enrollment/Change Form(PDF)(1PP,399KB)

PRESCRIPTION COVERAGE INFORMATION - MEDTIPSTER:

• Claim form - Prescription Form (PDF)(1PP, 396KB)

VISION COVERAGE INFORMATION:

• Optical Enrollment/Change Form (PDF)(1PP, 509KB)

LIFE INSURANCE COVERAGE INFORMATION - MADISON NATIONAL:

• Change of Beneficiary Form (PDF)(2PP, 1041KB)
• Employee Assistance Program (EAP)
• Enrollment Form (PDF) (1PP, 416KB)
• Identity Theft Assistance

VOLUNTARY BENEFITS 

• Trustmark (PDF) (1PP, 79KB)
• Unum(PDF)(2PP,104KB)

FLEXIBLE SPENDING ACCOUNT INFORMATION - Employee Benefits Concepts:

• https://www.ebcflex.com  
• What is an FSA?(PDF)(2PP,471KB)
• Sign up Now (PDF)(1PP, 384KB)
• ​FSA Expense List (PDF)(2PP, 49KB)
• Daycare(PDF) (1PP,383KB)
• Dependent Care Reimbursement Form(PDF) (1PP, 712KB)
• Elder Care(PDF)(1PP, 384KB)
• Medical Expense Reimbursement Form (PDF) (1PP, 464KB)
• WPS Debit Card (PDF) (2PP, 1174KB)
• Understanding Agreement(PDF) (1PP,37KB)
• WPS 2020 Election Form (PDF) (1PP, 250.49KB)