Fringe Benefits-Employee Forms clone

Benefit Enrollment Guides (Posted 11/14/2022):

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 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)(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)