Employee Benefits Policy & Procedures Manual

 

Health Insurance General Forms and Documents

• 2013 Open Enrollment Benefit Guide

• Newhire Benefit Guide

• Medical Plan Benefit Comparison

• 2013 Benefit Summaries

• 2013 Rate Sheet - Full Time 40 hour schedule

• 2013 Rate Sheet - Percentage reduced hour schedule

• IRS Publication 501-Dependent Eligibility Information

• Universal Enrollment/Change Form

• Medical Waiver Form

• COBRA Rights Information

• County Benefit Enrollment Forms

Medical Plan Information

• Stanislaus County Partners in Health (SCPH) HDHP Plan/HSA Enrollment Packet

• Stanislaus County Partners in Health (SCPH) EPO Enrollment Packet

• Stanislaus County Partners in Health (SCPH) Summary Plan Document (SPD)

• SCPH/Capitol Administrators Health Insurance Claim Form

• SCPH/CVS Caremark Pharmacy Mail Order Form

• SCPH/CVS Caremark Prescription Reimbursement Claim Form

• Anthem BlueCross EPO Plan Enrollment Packet

• Anthem BlueCross Lumenos PPO High Deductible Plan/HSA Enrollment Packet

• Anthem BlueCross EPO Summary Plan Document (SPD)

• Anthem BlueCross Lumenos PPO High Deductible Plan Summary Plan Document (SPD)

• Anthem BlueCross Transition Assistance Form

• Anthem BlueCross Disabled Dependent Form

• Anthem/Express Scripts Pharmacy Mail Order Form

• Kaiser Permanente HDEPO Plan/HSA Enrollment Packet

• Kaiser Permanente EPO Plan Enrollment Packet

• Kaiser Permanente HDEPO Summary Plan Document (SPD)

• Kaiser Permanente EPO Summary Plan Document (SPD)

• Out of Area Waiver Form

 

Health Savings Accounts

• Health Savings Accounts (HSA) FAQ

• HSA Payroll Deduction Contribution Form

• Wells Fargo HSA Account Rollover Form

• Wells Fargo IRA to HSA Transfer Form

 

Dental Plan Information

• Delta Dental PPO Enrollment Packet

 

Vision Plan Information

• Vision Service Plan Description

 

Life Insurance and Long Term Disability

• Reliastar Life Insurance Enrollment/Change Form

• Reliastar Life Insurance Evidence of Insurability

• Reliastar Life Insurance Policy

• Reliastar Management Long Term Disability Policy

• Reliastar ING Employee Assistance Plan Information

 

Humana Voluntary Benefits

• Humana Policy Cancellation Form

• Humana Critical Illness Policy Health Screening Claim Form

 

Flexible Spending Accounts

• Flexible Spending Account Health Care Claim Form

• Flexible Spending Account Dependent Care Claim Form

• FSA Direct Deposit Enrollment Form

• Over the Counter Fact Sheet

 

Deferred Compensation- Hartford

• Hartford 457 Loan Packet

• Hartford Enrollment Packet

• Hartford Enrollment Form

• Hartford Address Change Form

• Hartford Beneficiary Designation Form

• Hartford Contribution Change Form

• Hartford Direct Deposit Authorization Form

• Hartford Hardship Withdrawal Request Application

• Hartford Pre-Retirement Catch-Up Form

• Hartford Rollover Plan to Plan Transfer Form

• Hartford Rollover Provider to Provider Transfer Form

• Hartford Systematic Payment Change

• Hartford Systematic Payment Enrollment

• Hartford Withdrawal Request Form

• Hartford Withholding Authorization Form

PARS- Public Agency Retirement System

• PARS Designation of Beneficiary Form

• PARS General Information Sheet

• PARS Plan Summary

• PARS Government Pension Offset Info

• PARS SSA-1945 Cover Letter

• PARS SSA-1945 Notification

• PARS Windfall Eliminate Provision Info

 

eBenefits

• Self Service Information

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