2023-2024 Employer-Sponsored Health Care Plans
Professional and Administrative Employees
PDF File
LBT Enrollment Form
March 27, 2023
PDF File
PPO Benefit Summary 7-1-23
May 17, 2023
PDF File
Spouse ER Verification Form at OE
March 27, 2023
Support and Confidential Employees
PDF File
LBT Enrollment Form
March 27, 2023
PDF File
PPO Benefit Summary 7-1-23
May 17, 2023
PDF File
Spouse ER Verification Form at OE
March 27, 2023
PDF File
Support Spouse Eligibility Certification
March 27, 2023
Additional Forms
PDF File
Dependent Care- Quick Start Guide
May 5, 2022
PDF File
Spouse Employer Verification Form
May 5, 2022
Dental Coverage
PDF File
Delta Dental (May 2022)
May 19, 2022
Mandatory Postings
PDF File
2021 Marketplace Notice
May 4, 2022
PDF File
2021 Medicare Part D Notice
May 4, 2022
Flexible Spending Account (FSA)
PDF File
Flexible Spending Account FAQ
May 5, 2022
PDF File
Flexible Spending Account FAQ 4 2023
March 27, 2023
PDF File
FSA Election Form- Existing
May 5, 2022
PDF File
FSA Election Form Existing July 2023.docx
March 27, 2023
PDF File
FSA Election Form- NEW
May 5, 2022
PDF File
FSA Election Form NEW July 2023
March 27, 2023
Vision Coverage
PDF File
Davis Vision (May 2022)
May 19, 2022
Wellness Highlights
PDF File
Baby BluePrints
May 4, 2022
PDF File
Cancer Screening
May 4, 2022
PDF File
Care- Female
May 4, 2022
PDF File
Diabetes- Highmark Prevention Program
May 4, 2022
PDF File
Diabetes- Retrofit Program
May 4, 2022
PDF File
Diabetes- YMCA Prevention Program
May 4, 2022
PDF File
Hydration
May 4, 2022
