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Thursday, September 19, 2019 ..:: District Forms » Insurance ::.. Register  Login
 Insurance Minimize
 TitleOwnerCategoryLast UpdatedSize (Kb) 
2018-2019 Insurance Plans, Rates and Cost Calculator Stephanie Tafolla 7/11/2018 14.75 Download
2019-2020 Insurance Plans, Rates and Cost Calculator Stephanie Tafolla 6/3/2019 15.62 Download
2019-2020 Medical, Dental and Vision Plans (Please see calculator for eligible plans and rates) Stephanie Tafolla 6/3/2019 Unknown Download
Employee Assistance Program Stephanie Tafolla 10/19/2018 159.38 Download
OEBB 2018-2019 Mid Year Change Form Stephanie Tafolla 8/13/2018 217.83 Download
OEBB 2018-2019 New Member Enrollment Form Stephanie Tafolla 8/13/2018 217.15 Download
OEBB 2018-2019 Open Enrollment Guide Stephanie Tafolla 8/13/2018 4,465.56 Download

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 Opt Out and Waiver Forms Minimize
 TitleOwnerCategoryLast UpdatedSize (Kb) 
Insurance Benefits Waiver Form- (no other group coverage) Molly Lee 8/14/2017 Unknown Download
Insurance Opt-Out Form - Cash Incentive (other group coverage) Molly Lee 7/19/2019 Unknown Download

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 HRA/VEBA Minimize
 TitleOwnerCategoryLast UpdatedSize (Kb) 
HRA Benefits Brochure Stephanie Tafolla 5/11/2018 3,455.56 Download
HRA VEBA Incentive Form Molly Lee 7/19/2019 Unknown Download
HRA VEBA Website Molly Lee 8/10/2016 Unknown Download
VEBA - How to File a Claim Molly Lee 8/10/2016 Unknown Download

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 Flexible Spending Account: Section 125/Cafeteria Plan Minimize
 TitleOwnerCategoryLast UpdatedSize (Kb) 
Benefit Help Solutions Website Stephanie Tafolla 5/15/2013 Unknown Download
FSA Information Stephanie Tafolla 11/2/2011 2,022.36 Download
FSA Information Flyer Stephanie Tafolla 11/2/2011 167.77 Download
Master Plan Document Stephanie Tafolla 9/24/2018 475.54 Download
Premium Contribution Opt Out Form Stephanie Tafolla 8/2/2011 16.08 Download
Section 125 (FSA) Enrollment Form Stephanie Tafolla 9/21/2016 99.50 Download
Status Change Form Stephanie Tafolla 8/2/2011 86.29 Download
Summary Plan Description Stephanie Tafolla 9/24/2018 279.43 Download

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 Optional Benefits Minimize
 TitleOwnerCategoryLast UpdatedSize (Kb) 
AFLAC- Optional Plan Stephanie Tafolla 6/15/2017 93.79 Download
Horace Mann Insurance Stephanie Tafolla 7/3/2017 Unknown Download

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