What Do I Need to Do?
Step 1: Refer to your bargaining agreement to learn about benefits available to you.
Step 2: Review the benefit election form.
Step 3: Confirm benefit elections for plan year 2019-2020 by completing the benefit election form.
Step 4: Sign and return the benefit election form and enrollment change forms to human resources by May 31, 2019.
2019-2020 Enrollment/Change Forms
Print out, complete, and return the necessary forms to Human Resources by May 31, 2019.
Medical - HSA Funding - Term Life
- Anthem Enrollment/Member Change form
- Waiver of Insurance Form
- Benefit Cancellation Request Form
- Section 125 Pre-Tax Premium Cost Share Enrollment Form
(Note: Employee must be enrolled in High Deductible Health Plan (HDHP) to Participate)
Long-Term Disability (LTD)
Health Care/Dependent Care Flexible Spending Account (FSA)
- Flexible Spending Accounts (FSA) - Health/Dependent Care Enrollment Form
- Employees not enrolled in an HSA may participate in the healthcare FSA
- Employees enrolled in an HSA may participate in the limited purpose FSA (new)
- All eligible employees may enroll in the dependent-care FSA
403b Forms (Voluntary Participation)
Health Savings (HSA) / Flexible Spending (FSA)
Health Savings Account (HSA)
*If you are not eligible to participate in an HSA, please contact Human Resources.
2019-2020 School Administrators
2019-2020 Central Office Administrators
2019-2020 Central Office Staff Benefit Package (Superintendent's Secretary, Data Manager, HR Staff, Accounting Supervisor, IT Staff, Security Staff, Head Nurse, and Occupational Therapist)
Century Preferred PPO plan summary (dependent eligibility to age 26)
- PPO Fact Sheet
- PPO Informational Booklet
- Prescription (PPO Plan)
- Vision Rider (included in PPO plan only)
Long-Term Disability (Voluntary LTD)
Term Life Insurance
- NON-CERTIFIED STAFF HIRED PRIOR TO 7/1/12: