Fringe Benefits-Employee Forms
Benefit Enrollment Guides:
Open Enrollment for Health Benefits is open from November 14th, 2022 thru December 7th, 2022. Please click the link that matches your position with Wyandotte Public Schools, read the guide and follow the instructions.
OPEN ENROLLMENT POWERPOINT PRESENTATION:
- CLICK HERE for a PowerPoint presentation from Gallagher explaining the available plan options for 2023.
INSURANCE PLAN SUMMARIES:
- Administrators (PDF)(20PP, 6.89MB)
- Teachers (PDF)(20PP, 5.48MB)
- Administrative Assistants (20PP, 6.46MB)
- Maintenance (PDF)(20PP, 5.48MB)
- Paraprofessionals (PDF)(20PP, 5.50MB)
HEALTH COVERAGE INFORMATION - BLUE CROSS:
- Choices for Care (added 5/27/2022)(PDF) , (2PP, 126KB)
- Affordable Care Act
- Change of Status(PDF) See Page 6 (9PP, 800KB)
- Employee Enrollment Form (PDF) See Page 2(9PP, 800KB)
- Health Savings Account (HSA) Enrollment Form - 2023(PDF) (1PP, 265.51KB)
- Michigan No-Fault Auto Insurance Change Letter (PDF) (1PP, 391KB)
- No Surprises Act (PDF) (1PP, 138KB)
DENTAL COVERAGE INFORMATION - ADN:
- Plan Information(PDF)(20PP, 6235KB)
- Enrollment/Change Form(PDF)(1PP,399KB)
PRESCRIPTION COVERAGE INFORMATION - MEDTIPSTER:
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)(567KB)
- Enrollment Form (PDF) (1PP, 416KB)
VOLUNTARY BENEFITS
- Trustmark (PDF) (1PP, 79KB)
- Unum(PDF)(2PP,104KB)
FLEXIBLE SPENDING ACCOUNT INFORMATION - Employee Benefits Concepts:
2023 Plan Year Information:
- Group Resources-Summit (Link to Claims Website)
- Welcome to Summit (Claims Website Information) (PDF)(1PP, 389KB)
- What is a FSA?(PDF)(2PP,433KB)
- Sign up Now (PDF)(1PP, 402KB)
- FSA and DCA Expense List (PDF)(2PP, 593KB)
- Direct Deposit ACH Form (PDF) (1PP, 465KB)
- WPS Debit Card (PDF) (2PP, 1174KB)
- Understanding Agreement(PDF) (1PP,23KB)
- WPS 2023 Election Form (PDF) (1PP, 271KB)