Open Enrollment
Open Enrollment - 2013 Benefit Period
Benefit Information
- Open Enrollment Packet
Print and bring packet with you to your Open Enrollment meeting. - 2013 Non-Tobacco Use Declaration Form
- Open Enrollment Calendar
- Payroll Schedule 2013
- Shared Leave Donation Form
Health Plan:
Cigna- Health, Dental, and MedTrak Enrollment Form
- Cigna Claim Form - Medical
- Cigna Claim Form - Vision
- Preventive Care Guidelines
For more information about Cigna: www.mycigna.com
Prescription Plan (MedTrak)
For more information about MedTrak: www.medtrakservices.com
Delta Dental
For more information about Delta Dental: www.deltadentalks.com
Flexible Spending Accounts:
- FSA Enrollment Form
- FSA Debit Card Application
- FSA Claim Form
- Medical Expense Worksheet
- Online Enrollment Instructions
For more information: www.asiflex.com
Fitness Club Memberships:
You MUST submit the payroll deduction form AND the membership agreement form to the Human Resources office.
- Fitness Club Payroll Deduction Form
- Genesis Fitness Agreement
- Jazzercise Agreement
- OrthoKansas Membership Contract – Full Program
- OrthoKansas Membership Contract – Pool only
- Punch Fitness Membership Agreement
- LAC Fitness Membership Agreement
- The Summit Fitness Membership Agreement
Kansas Public Employees Retirement System (KPERS):
- KPERS Membership Guide
- KPERS Tier 1 Benefits At A Glance (employed prior to July 1, 2009)
- KPERS Tier 2 Benefits At A Glance (employed after July 1, 2009)
- KP&F Membership Guide
- KP&F Benefits At A Glance
- Optional Group Life Insurance Brochure and Application
For more information www.kpers.org
Deferred Compensation / 457 Plan:
For more information: www.divinvest.com
Voluntary Life Insurance:
- AICK Voluntary Life Summary
- AICK Voluntary Life Enrollment Form
- KPERS Optional Group Life Insurance Brochure and Enrollment Form
