Fringe Benefits-Employee Forms

Benefit Enrollment Guides (Posted 11/9/2020):

Open Enrollment for Health Benefits is open from November 9th, 2020 thru November 23rd, 2020.  Please Click the link that matches your position with Wyandotte Public Schools, read the guide and follow the instructions.

OPEN ENROLLMENT PRESENTATION:

WPS OE Presentation

INSURANCE PLAN SUMMARIES:

• Administrators (PDF)(17PP, 3MB)
• Teachers (PDF)(17PP, 2MB)
• Administrative Assistants (17PP, 3MB)
• Maintenance (PDF)(17PP, 2MB)
• Paraprofessionals (PDF)(17PP, 2MB)

HEALTH COVERAGE INFORMATION - BLUE CROSS:

• 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)(PDF) (1PP, 265.51KB)
• Michigan No-Fault Auto Insurance Change Letter (PDF) (1PP, 391KB)

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,434KB)
• Sign up Now (PDF)(1PP, 418KB)
• ​FSA Expense List (PDF)(2PP, 593KB)
• 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 2021 Election Form (PDF) (1PP, 250.49KB)