Fringe Benefits-Employee Forms clone

 

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)(567KB)
• Enrollment Form (PDF) (1PP, 416KB)

VOLUNTARY BENEFITS 

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

FLEXIBLE SPENDING ACCOUNT INFORMATION - Employee Benefits Concepts:

• Welcome to Summit (Claims Reimbursement Website Information) 
• https://groupresources.summitfor.me/ (Claims Reimbursement Link)
• What is an FSA?(PDF)(2PP,434KB)
• Sign up Now (PDF)(1PP, 418KB)
• ​FSA and DCA Expense List (PDF)(2PP, 593KB)
• WPS Debit Card (PDF) (2PP, 1174KB)
• Direct Deposit ACH Form
• Understanding Agreement(PDF) (1PP,37KB)
• WPS 2023 Election Form (PDF) (1PP, 250.49KB)