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.
2019 UPDATES & CHANGES
2019 Workplace Wellness Flyer Retiree Version
2019 Open Enrollment Meeting Schedule
Online Enrollment for 2019
2019 Open Enrollment Forms-INTERNAL LINK-USE THIS IF YOU ARE USING A WORK COMPUTER
2019 Open Enrollment Forms-EXTERNAL LINK-USE THIS IF YOU ARE USING A PERSONAL COMPUTER
2019 Open Enrollment Instructions
2019 MEDICAL/DENTAL COVERAGE
All basic medical plan packages include health and dental coverage options-you choose the network.
2019 Health Savings Account vs Flexible Spending Account
Health Savings Account-Old National Bank
4D Pharmacy Mail Brochure - Magellan Rx
4D Pharmacy Mail Order Form - Magellan Rx
OPTIONAL SPECIALIZED COVERAGE
VISION PLAN2019 Vision Plan Benefits Summary
LIFE & ACCIDENTAL DEATH/DISMEMBERMENT & SHORT AND LONG TERM DISABILITYSymetra-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-All Others
Summary of Short Term Disability Benefits
Summary of Long Term Disability Benefits
SUPPLEMENTAL ACCIDENT & SICKNESSColonial Life-Accident Policy
Colonial Life - Critical Illness Policy
Colonial Life - Whole Life & Long Term Care
Colonial Life-Policyholder Service Guide
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
GENERAL NOTICES
A selection of medical health related City policies
Family Medical Leave Information
Grandfathered Health Plan Notice
RETIREMENT BENEFITS
Retirement plans & savings options.
457 Plan-Lincoln Financial Group
WELLNESS BENEFITS
Guidelines for Healthly Lifestyle Benefit
Healthy Lifestyle Reimbursement Form