Benefits

OPEN ENROLLMENT

Administrators, Administrative Assistants,  AFSCME, AFT and Teamsters - July 1, 2020 through June 30, 2021

Open Enrollment changes are due on or before May 22, 2020.  If you have any questions, please email Jeanne Portalski at jportalski@mywwps.org

Priority Health - Medical Benefits

Priority Health Enrollment Form

Priority Health POS Summary of Benefits

Priority Health PPO Summary of Benefits

Priority Health HMO Summary of Benefits

Priority Health PPO/HSA Summary of Benefits

Waiver of Medical Benefits - if you are waiving Medical Benefits through the District, the IRS requires you to submit a Waiver each Plan Year with a copy of your proof of other coverage, i.e. a copy of your Medical ID Card or a statement from your carrier.

Waiver of Coverage Form

ADN Dental  - Dental Benefits

ADN Dental Enrollment Form

ADN Dental Summary of Benefits

NVA Vision - Vision Benefits

NVA Vision Enrollment Form

NVA Vision Summary of Benefits

Reliance Standard Life and Accidental Death and Dismemberment Coverage

Reliance Standard Beneficiary Form


 

Non Teacher Life Insurance
Administrators
Administrative Assistants - Non Union
AFSCME
Paraprofessionals - AFT
Teamster
Retired Administrators
Retired Teamster 

Non Teacher Long Term Disability
Administrators
Administrative Assistants - Non Union
AFSCME
Paraprofessional - AFT
Teamster 

Teacher Benefits
Teachers MESSA Choices Plan Benefits - PAK A
Teachers MESSA ABC Plan 1 Benefits - PAK C
Teachers MESSA ABC Plan 1 with 20% Co-Insurance - PAK D
Teachers MESSA ABC Plan 2 with 20% Co-Insurance - PAK E
Teachers MESSA Delta Dental Benefits - PAK A ,C,D & E
Teachers MESSA Delta Dental Benefits - PAK B
Teachers MESSA VSP Gold Vision Coverage -All PAKS
Teachers MESSA Life & Accidental Death Benefits - PAK A, C, D, & E
Teachers MESSA Life & Accidental Death Benefit - PAK B
Teachers MESSA Long Term Disability Coverage - All PAKS
Teachers MESSA Basic Term Life - PAK A, C, D, & E

Group Resources Flexible Spending (FSA) and Dependent Care (DC)
Summary Plan Document - FSA
Summary Plan Document - FSA Limited Purpose Fund
Group Resources Direct Deposit Form
Group Resources Flexible Spending (FSA) Claim Form
Group Resources Dependent Care (DC) Claim Form

Health Equity - Health Savings Account (HSA)
* An updated form is required each calendar year

MESSA 2020 HSA Payroll Deduction Authorization

Priority Health 2020 HSA Payroll Deduction Authorization