Staff - Benefit Plans

Benefit Plans are available in pdf file format. If you do not have Adobe Acrobat Reader installed on your computer, click on the link to install it.

May 15, 2013 Additional Voluntary Life Insurance Opportunity

• Welcome Letter from Minnesota Life (includes rates for supplemental life insurance)
  
• Enrollment Form (Employee/Spouse/Children)
  
• Beneficiary Designation/Change
  
• Evidence of Insurability-this form is required for
  • any new additional coverage for Spouses, or
  • new employee coverage above $150,000 if employee already carries supplemental coverage, or
  • any requested supplemental coverage above $10,000 if employees are not already carrying supplemental coverage, or
  • all supplemental coverage (Employee or Spouse) requested after June 7, 2013.

April 24, 2012 - Presentation Video - Download/View

• Anthem Handouts, including Special Offers and Health Assessment
• Guided Tour of anthem.com Website

August, 2011 - Benefits Video Presentation - Download/View

September 19, 2011 -- HSA Overview Slideshow as presented at FHS Auditorium - View (updated to include 2013 figures)

• Health Insurance Election Form
• Anthem Original Plan Certificate of Coverage/Policy Booklet
• Anthem Plan B Certificate of Coverage/Policy Booklet
• Anthem HSA Certificate of Coverage/Policy Booklet
• HSA Debit Card Request Form
• HSA Qualified Medical Expenses
• HSA Special Reimbursement for Deductible Incurred within $2000-$2400 (individual) or $4000-$4800 (family) ranges
• Anthem Plan Summaries
  • Original
  • Option B
  • HSA Summary
• EBC (dental/vision) Policy Booklet
• EBC (dental/vision) Plan Summary
• CMS Medicare Part D Notification
• Anthem Mail Order Prescriptions Form
• Anthem Claim Form
• Flexible Spending Account Participant Resource (new link)
• Aflac-Wageworks Health Care Claim Form
• Aflac-Wageworks Dependent Care Claim Form
• COBRA General Notice
• EBC Dental Claim Form
• EBC Vision Claim Form
• Jefferson Pilot Life Insurance Policy (to be replaced by Minnesota Life effective June 1, 2013)
• Spousal Eligibility Form
• AFLAC-Continental Critical Illness Claim Form
• AFLAC-Continental Critical Illness Wellness Benefit Claim Form
• AFLAC-Continental Accident & Hospital Claim Form
• AFLAC-Continental Accident Wellness Benefit Claim Form

Options Information

• Summary of Options at a Glance and Important Jargon
• Anthem Plan Options Booklet 9/1/08 (Updated Version Coming Soon)
• HSA Enrollment Info and FAQ
• HSA vs. Original Health Option Worksheet