| BENEFITS — HEALTH, DENTAL & VISION PLAN INFORMATION |
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BCBSM Simply Blue HSA High Deductible PPO Plan ($1,400/$2,800)
BCBSM Simply Blue HSA Higher Deductible PPO Plan ($2,000/$4,000)
BCN HMO HSA High Deductible Plan
BCN HMO Traditional Plan
Blue Care Network - How it Works
Blue Care Network - Travel
Blue Care Network Contact Numbers
Blue Cross Blue Shield Custom Drug List Formulary
Blue Cross Blue Shield Plan Coverage Comparisons
Dental Benefits at a Glance
Vision Benefits at a Glance
Dependent Care Flexible Spending Account (FSA)
Employee Flexible Spending Account (FSA)
Winning with a Health Savings Account (HSA)
FAQs Related to Plans Offered for 2018 Open Enrollment
Employee Assistance Program
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BENEFITS — HEALTH, DENTAL & VISION ENROLLMENT, DEDUCTION &
REIMBURSEMENT FORMS |
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Enrollment Forms - Administrator & Supervisor
Enrollment Forms - Classified
Enrollment Forms - Early Childhood
Enrollment Forms - LIPSA
Enrollment Forms - Teacher Assistant
InfiniSource FSA Reimbursement Form
Guardian Enrollment Form
Flexible Spending Account (FSA) Deduction Form
Health Savings Account (HSA) Deduction Form
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| BENEFITS — LIFE and AD & D INSURANCE PLAN INFORMATION |
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Life and AD & D Insurance Policy - Administrator & Supervisor
Life and AD & D Insurance Policy - Classified
Life and AD & D Insurance Policy - Early Childhood
Life and AD & D Insurance Policy - LIPSA
Term Life Insurance Policy - RTC
Term Life Insurance Policy - RTC ≥ 5 Years of Service
Term Life Insurance Policy - Specialized
Term Life Insurance Policy - Specialized ≥ 5 Years of Service
Life and AD & D Insurance Policy - Teacher Assistant
Life / AD&D & Long-Term Disability Enrollment Form
Life Insurance Beneficiary Designation Form
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| BENEFITS — LONG-TERM DISABILITY |
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Long-Term Disability Policy - Administrator & Supervisor
Long-Term Disability Policy - Classified
Long-Term Disability Policy - Early Childhood
Long-Term Disability Policy - LIPSA
Long-Term Disability Policy - Specialized Transportation
Long-Term Disability Policy - Teacher Assistant
Long-Term Disability Insurance Claim Form
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| LEAVES OF ABSENCE & FMLA |
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FMLA Notice to Employees
FMLA Fact Sheet
FMLA Checklist
Leave of Absence Request
Short-Term Disability Request
FMLA Certification of Health Care Provider - Employee
FMLA Certification of Health Care Provider - Family Member
Return to Work Certification
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| CONFERENCE ROOM RESERVATIONS |
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Conference Room Request Form
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| FINANCE |
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Daily Meeting & Mileage Reimbursement Request Form
Professional Learning Approval & Reimbursement Request Form
Purchase Reimbursement Request Form
Purchase Requisition (Check Request) Form
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| HUMAN RESOURCES |
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Address/Telephone/Name Change
AFSCME Sick Day Cash Out Request
Parent / Volunteer Affidavit
Personnel Action Request
Student Teacher / Intern Affidavit
Third Party Visitor
Transfer/Status Change Request [LIPSA]
Transportation - Bus Driver Signing Bonus (Installment I)
Transportation - Bus Driver Signing Bonus (Installment II)
Transportation - Bus Assistant Signing Bonus
Transportation - Bus Driver Recruiting Bonus
Transportation - Bus Assistant Recruiting Bonus
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| PAYROLL |
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W-4 Federal
W-4 Michigan
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| RETIREMENT |
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Office of Retirement Services (ORS)
MiAccount
Social Security Administration
403(b) Presentation
403(b) Enrollment Brochure (effective 01/01/19)
403(b) Default Investment Fund (effective 01/01/19)
Plan Fee Disclosure Statement (effective 01/01/19)
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| STUDENTS & PARENTS |
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Authorization for Publicity
Field Trip Permission Slip (with Parent / Volunteer Affidavit)
Medical / Emergency Information
Student Incident Report
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| WORKER'S COMPENSATION |
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Authorization for Treatment
Employee Incident Report
Answers to FAQs
Process for Filing a Claim
Supervisor's Report of Incident
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