FORMS & More!

by Jackie Wells, Business Manager

CERTIFIED Summary of Benefits
CLASSIFIED Summary of Benefits

2024-2025 Monthly Insurance Rates

If you are currently enrolled in the district's WELLMARK Health Plan, but want to change plans, please complete 
        Wellmark Current Enrollment & Waiver

If you are not enrollment in the district's WELLMARK Health Plan, but wish to enroll, please complete
    Wellmark Health Insurance Application

If you have any changes to your personal information OR want to cancel a family member from coverage, please complete
    Wellmark Change Form

WELLMARK Benefit Summary of Benefits

Wellmark $1000 Deductible Summary of Benefits

Wellmark $4000 HDHP Summary of Benefits

Wellmark $5000 Deductible Summary of Benefits

HSA Payroll Deduction Form
HSA Bank Enrollment Form



Lincoln Financial At-A-Glance _ Life & ADD Insurance

Lincoln Financial Enrollment Form

LIFE Insurance Booklet

LTD Insurance Booklet

Ameritas_Vision EyeMed Insurance Summary of Benefits
Ameritas_Vision VSP Summary of Benefits

Ameritas_Vision Enrollment Form


Delta Dental At-A-Glance Booklet

Delta Dental Enrollment Form

Delta Dental Benefit Booklet

EMC On-Call Nurse - Work Related Injury

EMC ON-CALL Nurse

Master Contract 2024-2025
Employee Handbook 2024-2025
BENEFITS_Classified

Family Medical Leave Act
FMLA Additional Information
Central Lyon ~ Policy 409.03, pages 98-111 ~ https://www.centrallyon.org/vimages/shared/vnews/stories/4832dfb304db0/Series_400_3-2021.pdf
FMLA Certifications
    Maternity Leave
    Employee Serious Health Condition
    Family Serious Health Condition

Direct Deposit Authorization
Section 125 _ Change in Status for Insurance Enrollment

IRS I-9 form
IRS W9 Form
 

Federal W4 _ 2025
Iowa W4 _ 2025