Benefit Services Forms and Documents
Employee Benefits Forms
- Benefits Guide pdf
- Employee Contributions 26 pay pdf
- Employee Contributions 20 pay pdf
- Summary Plan Description pdf
- Accessing Employee Benefits pdf
- Event Documentation Requirements pdf
- Tip Sheet - Uploading Benefit Documentation pdf
- Other Eligible Adult Enrollment Affidavit pdf
- Other Eligible Adult Termination Affidavit pdf
- Other Eligible Adult Imputed Income pdf
- Employee Separation Benefits pdf
- Medical-Rx At-A-Glance pdf
- HDHP Single Summary of Benefits pdf
- HDHP Family Summary of Benefits pdf
- PPO Summary of Benefits pdf
- BC of Idaho Member Claim Form pdf
- CVS Member Rx Claim Form pdf
- EAP Summary of Services pdf
- EAP Legal-Financial Services pdf
- EAP Work-Life Balance pdf
- EAP Management-Consultation Services pdf
- Retirement Plans Overview pdf
- PERSI Beneficiary Designation pdf
- Supplemental Retirement Vendors and Plans pdf
- Supplemental Retirement Account Authorization Form pdf
Employee Leave Forms
Legal Notices and Certificates
- LTD-ORD Certificate pdf
- ACA Notice pdf
- CHIP Notice pdf
- HIPAA Rights pdf
- Required Legal Notices pdf
- STD Amendment pdf
Retirement Planning Forms
- Retirement Planning Checklist doc
- Planned Retirement Program Application pdf
- Planned Retirement Program Letter pdf
- Retiree Election Form pdf
- U of I Presentation pdf
- U of I Handouts pdf
- 90 Days From Retirement Presentation pdf
- 90 Days From Retirement Handouts pdf
Current Retiree Forms
- Pre Medicare Benefits-At-A-Glance pdf
- Post Medicare Benefits-At-A-Glance pdf
- Silverscript Summary of Benefits pdf
- Retiree Summary Plan Description pdf
- CMS Notice of Creditable Coverage pdf
- HRA FAQ pdf
- Retiree ACH Form pdf
- Retiree Rates - Tier 1 pdf
- Retiree Rates - Tier 2 pdf
- Retiree Rates - Tier 3 pdf
- Retiree Rates - Tier 4 pdf
- Retiree Tier 1 Death Benefit Beneficiary Form pdf
- Retiree Tier 1 Death Benefit Summary pdf