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Salary Reduction Agreement
Complete the form on-line, print and sign. Fax the completed form to (863) 688-4466
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Announcements
Employee Portal
Employee Portal
One spot for all your needs. Information on Payroll, Leaves, Benefits & Deductions, Employee Directory, etc.
Medical/Drug
United Health Care
Benefit Summary - Choice Plus
Last Update 10/4/11
Plan Description - Choice Plus
Last Update 1/25/12
Benefit Summary - Pharmacy
Last Update 10/4/11
Benefit Summary - PPO
Last Update 10/4/11
Plan Description - PPO
Last Update 1/25/12
Health Plan Enrollment Form
Last Update 1/9/12
Health Plan Waiver and Release Form
Last Update 4/17/12
Prescription Drug Program
UnitedHealthcare National Pharmacy Network
Changes Effective Jan 1, 2012
Changes Effective July 1, 2011
Dental
Delta Dental
Dental Benefit Summary
Last Update 11/1/11
Dental Summary Plan Description
Last Update 1/13/12
Vision
National Vision Administrators
Summary of Benefits
Flexible Spending Accounts
Employee Benefits Corporation (EBC) Website
My Benny Card Website
Online Claim Instructions
Bestflex Summary Plan Descriptions
Last update 11/11/11
Flexible Spending Plan Description
Last Update 10/17/11
Flexible Spending Plan Worksheet
Last Update - 10/17/11
Flexible Spending Plan Grace Period
Last Update 10/17/11
Enrollment Form
Last Update 10/17/11
Benny Card Information
Last Update 10/17/11
Tax Savings Calculator
Last Update 10/20/10
Wellness HRA
Employee Benefits Corporation (EBC) Website
Online Claim Instructions
Wellness HRA Explanation
Last update - 12/21/11
HRA Summary Plan Description
Last Update 11/2/11
HRA Claim Form
Last Update 10/27/11
Long Term Disability
Long Term Disability Summary Plan Description
Last Update 11/2/11
Short Term Disability
Short Term Disability Enrollment Information
Last Update 1/31/12
Short Term Disability Calculation Form
Last Update 12/15/11
Short Term Disability Enrollment Form
Last Update 12/15/11
Short Term Disability Evidence of Insurability
Last Update 12/15/11
Short Term Disability Benefit Information
Last Update 12/15/11
Certificate of Insurance
Last Update 2/27/12
Life Insurance
Basic Life Insurance Summary
Basic Life Insurance Summary - Administrators
Basic Life Insurance Enrollment Form
Beneficiary Designation & Change Form
Life Insurance Evidence of Insurability Form
Tax Sheltered Annuity (403(b))
Universal Availability Notice
Last Update 10/20/10
Legal Notices
CHIPS Notice
Last Update 10/6/11
HIPAA Privacy Practices Notice
Last Update 10/20/10
Medicare Creditable Coverage Notice
Last Update 10/6/11
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