Staff Resources/Forms
OPEN ENROLLMENT
NEW HIRE/PAYROLL FORMS
HR/BENEFITS
Employee Assistance Programs:
EAP brochure
ID Theft brochure
Flex Spending (Omnify):
2023 Omnify-FSA-Payroll-Election-Form, (FSA&DCA)
Omnify Recorded Webinar Video
Dependent Care Flyer
Healthcare Flex Flyer
Dependent Care Claim Form
How to submit FSA (health) Claims
How to submit DCA Claims
Flex Spending Visa Card
Health/Dental Insurance:
Dental Summary
$850 Deductible Plan Document
$1200 Deductible Plan Document
$4000 High Deductible Plan Document
BCBS Enrollment/Change Form
BCBS Telehealth Member Flier
MyBlue Flier
Life Insurance:
Beneficiary Change Form
Life Insurance Enrollment Form
Evidence of Insurability Form
Long Term Disability:
LTD Summary
LTD Detail
LTD Enrollment Form
Evidence of Insurability Form
Medicare
Medicare Counseling &Education Resources
Medicare Information - Nebraska SHIIP
Retirement (NPERS):
NPERS Website
Beneficiary Change Form
Retirement Planning SeminarsÂ
Retirement - (403b)
403b Account Application 2023
Salary Reduction Agreement 2023
Employee Waiver Form (1)
Vision Insurance:
10 Month Enrollment Form
Vision Plan Summary - 10 month employee
12 Month Enrollment Form
Vision Plan Summary - 12 month employee