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BENEFITS
FORMS MANAGER
NEWLY
MARRIED EMPLOYEES
Please fill out, print and send the
attached
forms along with a copy of
your
marriage license to the Benefits Department within 30 days of
marriage.
ADDING
BENEFIT COVERAGE
Employees wanting to add benefit coverage due to qualifying events
such
as spouse's retirement, spouse's
loss
of coverage, divorce, death, etc.,
must
complete the attached forms and return them to the benefits office.
BASIC
FLEXIBLE SPEND PLAN
The
BASIC Flex Plan is available here and the reimbursement form.
BASIC
HEALTH FLEX
CAFETERIA
PLAN
MASTER
MEDICAL FORM (Blue Cross)
Claim
form for medical insurance.
DENTAL
CLAIM FORM (Principal)
Claim form for dental.
VISION
FORM (SET SEG)
Claim
form for vision insurance.
ADDRESS
CHANGE
ADDING/DELETING
A DEPENDANT TO YOUR INSURANCE
Please
fill out, print and send the attached forms along with the date of
birth for your child within 30 days of birth.
ANNUITY
SALARY REDUCTION FORM
Please
use this form to initiate new salary reduction, choose service
provider, change salary reduction, change service provider,
discontinue salary reduction, and to choose service provider for
Board Paid Tax Sheltered Annuity.
Eligible
457 Plan
ELIGIBLE
457 PLAN MULTIPLE PURPOSE ELECTION FORM
Please use this form to initiate new salary reduction, choose
service provider, change salary reduction, change service provider,
designate a beneficiary for the eligible 457 plan. This
election is for teachers and non-organized employees.
Contact
Numbers for Claims
Optional/enhancement
Benefits
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