Forms and Documents
Here are all the Employee Benefits online forms and documents in one location.
Health Insurance Forms and Documents
- Benefit eGuide 2024
- Employee Benefit Enrollment Form (Download and Open File in Adobe Reader to Sign and Return)
- Benefit Summaries
- Rate Sheet
- Adobe Reader Download
Medical Plan Information - HPNC and UHC
- Local Service Area Zip Code List
- HPNC HDHP Summary of Benefits and Coverage Notice (SBC)
- HPNC EPO Summary of Benefits and Coverage Notice (SBC)
- UHC HDHP Summary of Benefits and Coverage Notice (SBC)
- UHC EPO Summary of Benefits and Coverage Notice (SBC)
- Summary Plan Description (SPD) for Stanislaus County Health Plan
Prescription Pharmacy Network
Dental Plan Information - Delta Dental
- Delta Dental Core Plan Information
- Delta Dental Buy Up Plan Information
- Delta Dental Core Evidence of Coverage
- Delta Dental Buy Up Evidence of Coverage
Vision Plan Information- VSP
Life Insurance and Long Term Disability- Voya/ReliaStar
- Voya/ReliaStar Life Insurance Evidence of Insurability (EOI)
- Voya/ReliaStar EOI Instructions
- ReliaStar Life Insurance Policy
- ReliaStar Management Long Term Disability Policy
- ReliaStar Management Long Term Disability Summary
Accident Insurance
- Compass Accident Insurance Brochure
- Compass Wellness Benefit Test Requirement
- How to File a Wellness Claim
- Compass Accident Wellness Benefit Claim Form
- Compass Accident Insurance Claim Form
Critical Illness Insurance
- Compass Critical Illness Insurance Brochure
- Compass Wellness Benefit Test Requirement
- How to File a Wellness Claim
- Compass Critical Illness Wellness Benefit Claim Form
- Compass Critical Illness Insurance Claim Form
- Compass Critical Illness Insurance Physician Statement
Health Savings Account - OPTUM Bank
Flexible Spending Accounts - P & A Group
- Health Flexible Spending Account
- Dependent Care Assistance Flexible Spending Account
- FSA Qualified Expenses
- FSA Direct Deposit Authorization Form
- FSA Claim Form
457 Deferred Compensation - Nationwide
- Deferred Compensation Virtual Enrollment Kit
- Deferred Compensation Enrollment Link
- Beneficiary Form
- 2024 Tax Planning Quick Reference Guide
401a Plan - Nationwide
- 401a SSA-1945 Cover Letter
- 401a SSA-1945 Notification
- Government Pension Offset Info
- Windfall Elimination Provision Info
eBenefits
Manhattan Life (formerly Humana)
Health Insurance Information after Termination or Retirement
- Health Insurance Continuation - For participants leaving employment and currently enrolled in Stanislaus County health insurance.
- Retiree Medical Insurance - For StanCERA members not currently enrolled in Stanislaus County health insurance