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.
2021 UPDATES & CHANGES
NEW-2021 Open Enrollment Benefit Video
2021 Open Enrollment Forms
Open Enrollment Link-Internal Use Only - If you are using a City computer
Open Enrollment Link-External Use Only - If you are using a personal computer
2021 MEDICAL/DENTAL COVERAGE
All basic medical plan packages include health and dental coverage options-you choose the network.
2021 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 PLAN
LIFE & ACCIDENTAL DEATH/DISMEMBERMENT & SHORT AND LONG TERM DISABILITYSymetra-Beneficiary Designation Form
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.
2021 Flexible Spending Account Policy & Procedures
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
Managed Care Concept-Chronic Care Program
Managed Care Concept-Healthy Track