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.
View and/or print forms and information sheets below by clicking on the document title.
City of Fort Wayne Employee Benefits Guide
PHP INFORMATION and FORMS PHP Welcome Letter
PHP Coordination of Benefits Form - Email completed forms to This email address is being protected from spambots. You need JavaScript enabled to view it. or fax to 260-436-7235.
PHP Freedom Network Hospital Map
Click Here to Search For a Provider (Effective 1/1/25)
- Select "PHP Freedom Encore Combined" from the Network drop-down menu to search for in-network providers.
Guidelines for Healthy Lifestyle Benefit
Gym Club Reimbursement Form PHP
Healthy Lifestyle Reimbursement Form PHP
All basic medical plan packages include health and dental coverage options.
Medical Summary Plan Description
OPTIONAL SPECIALIZED COVERAGE
VISION PLAN
Vision Savings at Warby Parker
Vision Benefits for Children and Maternity
LIFE & ACCIDENTAL DEATH/DISMEMBERMENT & SHORT AND LONG TERM DISABILITY
Symetra-Beneficiary Designation Form
Symetra-Supplemental Life Application
Symetra-Evidence of Insurability Application
Estate Guidance
Financial Information & Resources
Legal Support
Confidential Counseling
Summary of Life Benefits - PBA
Summary of Life Benefits - IAFF
Summary of Life Benefits - FOP
Summary of Life Benefits - All Others
Summary of Short Term Disability Benefits
Summary of Long Term Disability Benefits
FLEXIBLE SPENDING ACCOUNTS and HEALTH SAVINGS ACCOUNTS
Enrolled employees have pre-tax program options to assist them in managing their medical and/or childcare expenses.
Health Savings Accounts vs Flexible Spending Accounts
Flex Childcare Reimbursement Form
Saving and Spending HSA Dollars
GENERAL NOTICES
A selection of medical health related City policies
Family Medical Leave Information
Grandfathered Health Plan Notice
RETIREMENT BENEFITS
Click on "RETIREMENT BENEFITS" above for informative video.
Retirement plans & savings options.
457 Plan Lincoln Financial Group
WELLNESS BENEFITS
Guidelines for Healthy Lifestyle Benefit
Gym Club Reimbursement Form PHP (Submissions after 12/20/24)
Healthy Lifestyle Reimbursement Form PHP (Submissions after 12/20/24)
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
ATLANTIC AMERICAN
Voluntary Whole Life Coverage
Atlantic American Benefit Summary
FEDERAL TRANSPARENCY in COVERAGE RULE
https://services.phpni.com/machine-readable-files/files/phpni/phpni