Payroll and Benefits – Documents

Payroll cutoff dates 2020 2021Download
Long Term Sub Teacher FormDownload

Basic Payroll Forms

Federal W4Download
State W4Download
IPERS Beneficiary FormDownload
Employee Information SheetDownload
Payroll Direct DepositDownload
Employee Emergency InformationDownload
RIC form 403b 1Download
RIC At a Glance 1Download
Health Plan ApplicationDownload
Dental Insurance ApplicationDownload
Flexible Benefits Reimbursement Claim FormDownload

Health Plan

Medical Plan Comparison SheetDownload
Core Plan Rates 21 22Download
HMO Essential 2021 22Download
PPO Choice 2021 22Download
PPO Premier 2021 22Download
HDHP with HSA Option 2021 22Download
Medical Plan Cost ComparisonDownload
HMO vs. HDHP with HSADownload
HMO vs PPODownload
MIIP Enrollment ChecklistDownload

Dental Plan

College CSD Dental Benefit OverviewDownload
Delta Dental Benefit SummaryDownload

Vision Plan

College CSD Vision Benefit OverviewDownload
Vision Benefit SummaryDownload
Eye Med FAQDownload
Eyemed Provider ListDownload
2021 eyemed wellness calendar dataDownload

Flexible Benefits Information

Dependent Care Provider Information FormDownload
Flexible Benefits Change of Family Status FormDownload
Flexible Benefits Card InformationDownload
Flexible Benefits Eligible ExpensesDownload

Annual Notices

Wellmark Website InformationDownload
Medicare Part D Notice and FAQDownload
Medicare Part D NoticeDownload
HIPAA NoticeDownload
CHIP NoticeDownload
Annual MIIP NoticeDownload
Health Plan Marketplace NoticeDownload
403B Annual Eligibility NoticeDownload

Life Insurance and Long Term Disability

Life Insurance Plan AdminDownload
Life Insurance Plan Confidential EmployeesDownload
Life Insurance Plan Food ServiceDownload
Life Insurance Plan TeachersDownload
Life Insurance Plan TeamstersDownload
Life Insurance Plan All OthersDownload
Life Insurance Plan all Other Non BargainingDownload
Life Insurance InformationDownload
Long Term Disability PlanDownload

American Fidelity

Disability Insurance

Accident Only Insurance

Cancer Insurance

Critical Illness Insurance

Life Insurance

Flexible Spending Accounts

Health Savings Accounts (HSA)

Calculators to Help Plan For Your Future

Medical Costs

Tax Savings

Retirement Savings

Customer Support Information

Customer Support

How to File a Claim

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