Fringe Benefits-Employee Forms

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:

• Benefit Advocacy Center (PDF) (1PP, 526KB)
• 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 - 2024(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:

• CVS Caremark/Medtipster Prescription Enrollment Form (PDF) (1PP, 396KB)

VISION COVERAGE INFORMATION - EYE MED:

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

LIFE INSURANCE COVERAGE INFORMATION - MADISON NATIONAL:

• Change of Beneficiary Form (PDF) (3PP, 666KB)
• Employee Assistance Program (EAP)(567KB)
• Enrollment Form (PDF) (1PP, 416KB)

VOLUNTARY BENEFITS 

• Trustmark(PDF) (10PP,1.71MB)
• 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)
• 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 2024 Election Form (PDF) (1PP, 271KB)