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)
- 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,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)