Employee Benefits
Employee Forms
- Employee Information Change Form
- Direct Deposit Authorization Form (Due to Security concerns all completed forms or changes must be submitted in person (will not accept emailed copies). No Exceptions.
- Form W-4
- Form M-4
Health Insurance
- Rate Letter
- Blue Cross Enrollment Form
- Required Documentation:
- If adding spouse – copy of Marriage Certificate
- If adding birth child – copy of Birth Certificate(s)
- If adding an adopted child or legal guardianship of child – copy of court document showing custody
- If adding a divorced spouse – copy of Divorce Decree showing requirement to cover an ex-spouse
- HMO & PPO Plan Design Comparison
- Network Blue New England Summary
- Network Blue New England Summary of Benefits and Coverage
- Blue Care Elect Summary
- Blue Care Elect Summary of Benefits and Coverage
- Blue Cross Blue Shield Plan Info
- Telehealth Member Brochure
- Weight Loss and Fitness Reimbursement Forms
- Non Hospital Imaging Centers
- Emergency Room Alternatives
- Nurse Hotline
- Step In Program
- My Blue Member App
- Using Find A Doctor
- Understanding Your Deductible
- Summary of Health Plan Payments Guide
- Health Insurance Opt Out Form
- Step In Program NEW
- Diabetes Care Value Program NEW
New Prescriptions
- Mail Service Pharmacy Brochure and Form
- CanaRX Enrollment Package
- CanaRX Formulary
- CanaRX Covid-19 Update
Dental Insurance
- Atlus Dental Summary of Benefits
- Atlus Dental Maximum Carryover Benefit
- Atlus Dental Enrollment Form
- Altus Dental Rate Letter
Deferred Compensations Plans
- Great West (Smart Plan) Contact Info
- Great West Appointment Scheduler
- Great West Plan Information (457 Deferred Compensation Plan)
- Nationwide Contact Info and Appointment Scheduler
- Nationwide Plan Information (457 Deferred Compensation Plan)
Optional Insurance
Other Benefits Offered
General Information
- FMLA General Guidelines
- COBRA Continuation Coverage
- Patient Protection Disclosure
- HIPPAA Notice of Privacy Practices
- Women's Health and Cancer Rights Act
- Premium Assistance (CHIP)
- The Uniformed Services Employment and Reemployment Rights Act (USERRA)
Quick Links
Deferred Compensation Plans (457)
Miscellaneous
- Cafeteria Plan Advisors Open Enrollment held in December of each year with effective date of January 1
- Employee Assistance Plan
Retirement