Employee Benefits Policy & Procedures Manual

 

Health Insurance

• Benefit Comparison 2009

• Benefit Comparison 2010- HMO Plans

• Benefit Comparison 2010- High Deductible Health Plans with HSA 

• Benefit Summaries 2009

• Benefit Summaries 2010

• Certificate of Dependent Status Eligibility Form

• IRS Publication 501-Dependent Eligibility Information

• Anthem Blue Cross Prescription Mail Order Form

• Anthem Blue Cross Transition Assistance Form

• Anthem Blue Cross Disabled Dependent Form

• Stanislaus Dental Foundation Plan Description 2009

• Stanislaus Dental Foundation Provider Directory 2009

• Vision Service Plan Description

• Universal Enrollment/Change Form 2009

• Universal Enrollment/Change Form 2010

• Waiver Form

• COBRA Rights Information 2009 including new premium Subsidy

Medical and Dental Enrollment Packets

• Anthem Blue Cross HMO Plan Enrollment Packet

  • Anthem Blue Cross HMO Provider Directory

• Anthem Blue Cross Lumenos PPO High Deductible Plan HSA Enrollment Packet 

  • Anthem Blue Cross Lumenos PPO Provider Directory

• Kaiser Permanente HMO Enrollment Packet

• Kaiser Permanente HDHP HSA Enrollment Packet

• Delta Dental Enrollment Packet 2010

 

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

 

Flexible Spending Accounts

• Flexible Spending Account Claim Form

• Flexible Spending Account Information Packet

• FSA Direct Deposit Enrollment Form

 

Deferred Compensation- Hartford

• Hartford 457 Loan Packet

• 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

Deferred Compensation- Diversified

• Diversified Direct Rollover Form

• Diversified Distribution Form

• Diversified Enrollment/Change Form

• Diversified Beneficiary Designation Form

• Diversified Hardship Withdrawal Request Application

• Diversified to Hartford Provider to Provider Transfer Form

• Diversified Pre-retirement Catch-up Provision Form

• Diversified Survivor Benefit Request 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

• eBenefits Self Service Information

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