Payroll

Forms
I-9    I-9 Form Only
W-4  W-4 Page 1
Direct Deposit Form
Drug Free Workplace Notice
Drug Free Workplace Acknowledgement

Time Sheet

Public Employees Retirement System of Idaho (PERSI)
Website
Beneficiary Designation
Choice 401k Forms and Information

Retiree Eligibility to take advantage of unused sick leave

Standard Life Insurance Company
Policy
Standard Life Enrollment Form

 
Blue Cross
Website

Employee Health Coverage Application

Employee Waiver of Coverage

Preferred Blue PPO for Statewide Schools - $1,000 Deductible

Persons Covered Total Cost Employee Cost
Employee $725.45 $-0-
Employee/Spouse 1,587.95 862.50
Employee/1 Child 1,127.95 402.50
Employee/2+Children 1,338.10 612.65
Family 1,888.75 1163.30

Summary of Benefits
Summary of Benefits 2
Rx

Common Summary of Benefits
Preventive Care Benefits
Dental Summary of Benefits - 2016
Vision Summary of Benefits - 2016

Women's Health and Cancer Rights Act of 1998 Notice
Notice of Privacy Practices
BlueExtras! brochure
CVS Caremark Mail Order Form







HSA Blue PPO for Statewide Schools - Economy Option - $3,000 Deductible

Persons Covered Total Cost Employee Cost
Employee $544.35 $-0-
Employee/Spouse 1,189.60 645.25
Employee/1 Child 849.10 304.75
Employee/2+Children 1,013.95 469.60
Family 1,427.00 882.65
District Contribution
to HSA
181.10 $-0-

Summary of Benefits
Summary of Benefits 2

Health Savings Account Limits - 2016