Classified Benefits
Open Enrollment Forms Accepted: October 10, 2016 - October 31, 2016 for a November 1, 2016 effective date.
Insurance Enrollment Change Form
Rate Chart effective 11/01/2016 (draft, ratification pending)
2016-2017 Classified Benefit Information (.500 - 1.00 FTE)
- 2016-2017 Medical, Dental, Vision Benefit Summary
- Prescription Drug Information, including a no cost preventive drug list (effective 11/01/2016, assuming ratification of contract)
- 2016-2017 Rate Chart effective 11/01/2016 (draft, ratification pending)
- 2016-2017 Rate Chart effective 07/01/2016
- Enrollment Change Form (pdf) -or- Enrollment Change Form (Word)
- Health Clinic Dependent Enrollment Form
Medical and Vision - PacificSource Health Plans
PSN Network Plans
- $500 deductible
- Benefit Handbook (coming soon)
- Summary of Benefits and Coverage (coming soon)
- $750 deductible
- Benefit Handbook (coming soon)
- Summary of Benefits and Coverage (coming soon)
- $1000 deductible
- Benefit Handbook (coming soon)
- Summary of Benefits and Coverage (coming soon)
SmartChoice Network Plans
- $500 deductible
- Benefit Handbook (coming soon)
- Summary of Benefits and Coverage (coming soon)
- $750 deductible
- Benefit Handbook (coming soon)
- Summary of Benefits and Coverage (coming soon)
- $1000 deductible
- Benefit Handbook (coming soon)
- Summary of Benefits and Coverage (coming soon)
General Notice of COBRA Continuation Rights
Dental - MODA or Willamette Dental
MODA
Willamette Dental
Section 125 - Flexible Spending Account
- Section 125 Enrollment form
- Health Risk Assessment Information
- Frequently Asked Questions
- Participant Portal User Guide
- Polestar Benefits, Inc Information Packet
- Section 125 Reimbursement Form
- Summary of Benefits and Coverage: FSA
- Flexible Benefits Plan Summary Plan Description
Life and Long Term Disability (LTD) Insurance-Cigna
Long Term Care Insurance (UNUM)