View and/or print forms and information sheets below by clicking on the document title.
NOTE: Life changes (e.g. marriage, birth of a child, divorce) that create an opportunity for or require a change in coverage must be reported to the Benefits Department within 30 days of the qualifying event.
2023 MEDICAL/DENTAL COVERAGE
All basic medical plan packages include health and dental coverage options.
2023 Medical Summary Plan Description
2023 Health Savings Account vs Flexible Spending Account
Magellan Rx Member Website Guide
OPTIONAL SPECIALIZED COVERAGE
LIFE & ACCIDENTAL DEATH/DISMEMBERMENT & SHORT AND LONG TERM DISABILITY
Symetra-Beneficiary Designation Form
Symetra-Supplemental Life Application
Symetra-Evidence of Insurability Application
Financial Information & Resources
Summary of Life Benefits-All Others
Summary of Short Term Disability Benefits
Summary of Long Term Disability Benefits
FLEXIBLE SPENDING ACCOUNTS
Enrolled employees have pre-tax program options to assist them in managing their medical and/or childcare expenses.
Flex Medical Debit Card Website
Flex Medical Reimbursement Form
Flex Childcare Reimbursement Form
A selection of medical health related City policies
Family Medical Leave Information
Grandfathered Health Plan Notice
Retirement plans & savings options.
457 Plan Lincoln Financial Group
Guidelines for Health Lifestyle Benefit
Healthy Lifestyle Reimbursement Form
Managed Care Concept-Chronic Care Program
Managed Care Concept-Healthy Track
Daavlin Home Phototherapy Benefit
Community Loan Center Of Northeast Indiana
UNUM CERTIFICATES OF COVERAGE
Voluntary Supplemental Employee Benefits
UNUM Accident Certificate of Coverage
UNUM Critical Illness Certificate of Coverage
UNUM Hospital Indemnity Certificate of Coverage
FEDERAL TRANSPARENCY in COVERAGE RULE
This link leads to the files that are made available in response to the Federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.