Benefit Handbook

Associated Files / Links

• Summary of Benefits
• Instructions for Provider Directory
• Instructions for EMI Mobile App

Benefit Change Forms

• Insurance change form

Summary of Benefits

• Summary of Benefits
• Flexible Benefits Plan Highlights
• Instructions for Login NBS Portal
• Instructions for NBS Mobile App

Note: For the plan year 2020-2021, maximum benefit amount is $2,750.00 with a $500 rollover.

For 2020-2021: Limited Purpose FSA for employees who chose the HDHP and HSA.

For plan year 2019-2020, maximum benefit amount is $2,700.00 with a $500 rollover.  

Benefit Change Forms

• NBS 125 Flex/Cafeteria Spending Enrollment Form

Employees must re-enroll for Flex spending every year during open enrollment. It can be used for medical and daycare expenses. Complete the enrollment form and submit to Tammara Robinson in HR Department.

Summary of Benefits

• Winning With A Health Savings Account
• HSA Fee Schedule
• If you elect the HDHP with the HSA during Open Enrollment, WCSD will deposit $80 into the HSA each month beginning in August 2019. WCSD will continue to match $20 each month in  Employee contributions in 2020-2021. 

Benefit Change Forms

• Health Savings Account Enrollment Form
• Changes to the contribution amount on the HSA can be made at any time during the year. Submit the HSA change form to Tammara Robinson in the HR Department.

• No associated forms at this time.

Summary of Benefits

• LifeMap Policy Information
• LifeMap Conversion Information
• LifeMap Advantages Flyer
• LifeMap Global Assistance Flyer
• AD&D Summary of Benefits
• Voluntary Life Summary of Benefits
• Basic Life Summary of Benefits

Benefit Change Forms

• LifeMap Life Insurance Enrollment Form
• LifeMap Beneficiary Designation Form

The LifeMap insurance enrollment form must be completed in full for any additional life insurance the employee wants to purchase for themselves, spouse, and/or children. Submit the forms to Tammara Robinson in the HR Department. Beneficiary changes can be made any time through out the year.

Regence Blue Cross Blue Shield Pharmacy Information:

Effective Jan. 1, 2018- Prime Therapeutics will replace Optum Rx. Here is what you can expect with the transition:

• Mail Order Changed from OptumRx to AllianceRx Walgreens
• Transferable prescriptions currently dispensed at OptumRx Home Delivery will transfer to the new mail order pharmacy automatically
• Non-transferable prescriptions are controlled substances (i.e. narcotics), compounds, drugs without refills, and expired prescriptions. Members will need to obtain new prescriptions for non-transferable prescriptions.
• Former Walgreens Mail Service members will need to validate their personal information with the new pharmacy
• New members will need to register and provide their payment information
• Specialty Pharmacy Change from BriovaRx to Alliance Rx Walgreens Specialty
• Personalized outreach to members will occur 14-24 days in advance to register and get members set up with new pharmacy
• Former Walgreens Specialty Pharmacy members will need to validate their personal information with the new pharmacy
• All RegenceRx info will all be included on the regence.com website.
• New Mail Order Registration Form

summary of benefits

regence blue cross blue shield:

• Summary of Benefits Blue Point Traditional Plan
• BCBS Benefit Book Blue Point Traditional Plan
• Summary of Benefits HDHP with HSA Plan
• BCBS Benefit Book HDHP with HSA Plan
• ACA Compliant SBC Blue Point Traditional Plan
• ACA Compliant SBC HDHP with HSA Plan
• Regence BlueCard Travel Information
• ACA Preventive Medications
• ACA Contraceptive Products
• ACA Tobacco Cessation Coverage

insurance change form for 2019-2020

• Insurance Enrollment / Change Forms

Forms must be completed in full for any insurance change and submitted to Tammara Robinson in the HR Department

Associated Files / Links

• Short Term Disability - Summary of Benefits
• Long Term Disability - LTD Certificate
• Lincoln Financial Privacy Notice

Short Term Enrollment FOrms

The Short Term Disability form must be completed in full for any insurance change and submitted to Tammara Robinson in HR Department.

• Insurance Enrollment and/or Change Forms

Associated Files / Links

• Accident Wellness Benefit Claim Form
• Accident Claim Form
• Critical Illness Wellness Benefit Claim Form
• Critical Illness Claim Form
• Hospital Indemnity Claim Form

Aflac Group Enrollment Form

• Aflac Rates
• Aflac Group Enrollment Form
• Information About Aflac Group Plans

Associated Files / Links

• Tier 2 Comparison

Benefit Change Forms

• URS 401k/457 Investment Contract

Changes to this form can happen any time throughout the year. Employees don't need to wait for open enrollment to make changes to their contributions, investment designation, or to their beneficiaries.The form must be completed in full and submitted to Tammara Robinson in HR Department.

This form must be completed for the pension and the 401(k)/457 accounts to be updated correctly.Employees don't need to wait for open enrollment to make changes to their accounts with URS.They would be filled out for name changes, marriage status changes, address changes, and beneficiary changes. The forms must be completed in full and submitted to Tammara Robinson in HR Department.

This form assigns beneficiaries.

Associated Files / Links

• Opticare Provider Listing

Benefit Change Forms

This form must be completed in full for enrollment and submitted to Tammara Robinson in HR Department.

• Opticare Enrollment Form