Staff Resources/Forms
OPEN ENROLLMENT
NEW HIRE/PAYROLL FORMS
HR/BENEFITS
Employee Assistance Programs:
EAP brochure
ID Theft brochure
Flex Spending (Omnify):
2022 FSA Enrollment Form
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 Application
Salary Reduction Form
Employee Waiver Form
Vision Insurance:
10 Month Enrollment Form
Vision Plan Summary - 10 month employee
12 Month Enrollment Form
Vision Plan Summary - 12 month employee