Benefits & Retirement
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Benefits & Retirement Team Benefits Providers Retiremen Manager Employe e Benefits Guide Benefits Calculator Sick leave Pool Program FICA Alternative Employe e Educational Scholarship Program Work/Life Balance
Forms & Brochures
Contact Information for All Insurance Carriers
Health Insurance Forms- 2012 Employee/Retiree Benefits Guide
- 2012 Health Insurance Election form
- 2012 Coventry Brochure
- 2012 HMO's by County
- Spouse Program Enrollment Form
- Surviving Spouse Program Enrollment Form
- BC/BS Claim Form
- Dependent Verification Form
- Major Medical/Comprehensive Claim Form
- Authorization to Disclose Personal Health Information
- Pre-tax Premium Waiver form
Life Insurance Forms
- Life Portability form
- Life Insurance Enrollment Form
- Group Life Beneficiary Designation
- Questionnaire Form (for Optional Life)
- Minnesota Life Insurance Booklet
Dental Forms
- 2012 Dental Insurance Election form
- Compbenefits (formerly American Dental Plan) Dental Brochure
- Compbenefits (formerly American Dental Plan) Dental Brochure
- Compbenefits (Network Plus Prepaid/Preferred Plus DPPO) Dental Brochure
- Ameritas Dental Brochure
- Assurant Dental Brochure
- Cigna Dental Brochure
- UnitedHealthcare Dental brochure
Supplemental Forms
- 2012 Accident Disability Insurance Election form
- 2012 Cancer Hospital Intensive Care Insurance Election form
- Long Term Disability Enrollment Form
- Long Term Disability Claim Form
- Long Term Disability Brochure
- Evidence of Insurability
- Colonial Claim Form
- State Securities Hospital Claim Form
- Supplemental Hospital Insurance Web Site
- AFLAC Brochure
- AFLAC Cancer Screening Wellness Benefit Claim Form
- Alta Brochure
- New Era Brochure
- Colonial Brochure
Vision Care
Retirement Forms- Tax Sheltered Annuity Representatives
- FRS General Retirement Plan Enrollment
- Optional Retirement Program (ORP16)
- Optional Retirement Program (ORP16a)
- Optional Retirement Program - Written Plan
- Salary Reduction Agreement Form
- FRS Beneficiary Form
- FRS Beneficiary Investment Form
- DROP Beneficiary Form
- DROP Brochure
- FRS Forms Web Site ( Forms Alphabetically)
- 403b Universal Availability Notice
- SUSORP Brochure
- FRS Termination Kit
- Retirement Options for New Employees
- FRS Investment Plan SPD (Summary Plan Description)
- FRS Reemployment after 7/1/2010
- Reemployment Rules for FRS Pension Plan and DROP Members
- Reemployment Rules for FRS Investment Plan Members
Preferred Legal
Tri-Rail
Employee Educational Scholarship Program
Sick Leave Pool
- Sick Leave Pool Application
- Sick Leave Pool Physician Statement
- Application for Sick Leave Pool Hours
- Family Medical Leave Act (FMLA)
- Sick Leave Pool Booklet
Flexible Spending Plan Forms
- 2012 Tax Favored Accounts Reference Guide
- 2012 FSA-HSA Election Form
- FSA Direct Deposit Form
- HIHP HSA Mailer
- myMRA(Medical Reimbursement Account) Card Mailer
- Flex Termination of Employment Form
- HSA Application
- Flex Spending Claim Form
- FSA-MRA Letter of Medical Need
Recreation and Fitness Center
Updated 11/15/2011
