Employee Benefits

Below you will find links to a variety of forms relating to employee benefits. If you have specific questions about coverage, please contact your Human Resources Manager.

Health:

Blue Shield Plan Description - PPO 500

Children's Providers Trust Claim Form (for Blue Shield PPO 500 only)

Blue Shield Plan Description - PPO 3000

Blue Shield Enrollment Form

Blue Shield Subscriber Change Request

Prescription Drug Coverage

Qualified Adult Dependent

Dental:

Dental Plan Description

Enrollment Form

Change Request Form

Vision:

Summary of Benefits

Enrollment/Change Request Form

Life:

Extended Life Application

Change of Beneficiary

Health Savings Plan (HSA) Information:

Reference Guide to Deductible and Non-Deductible Medical Expenses

Authorization/Enrollment Form

HSA Bank - Interest and Fee Schedule

Bank of America - Interest and Fee Schedule

Payroll Deduction Options:

Payroll Deductions Form

Salary Reduction Form