BENEFITS AND FORMS - Derby Public Schools

3-1 Supplemental Plan

BENEFITS AND FORMS

Effective Dates:
Deductible Year 1/1/21 - 12/31/21
Flex Spending Effective 1/1/21 - 12/31/21
Insurance Coverage 1/1/21 - 12/31/21

Website and Enrollment Information
2021 Benefit Guide Video
2021 Benefit Guide
Online Enrollment/Change of Benefits (Infinityhr.com)
Open Enrollment Screen Shots

USD 260 PLAN DOCUMENT

BCBS
Summary Plan Documents
Contracting Pharmacy in 67037 area
Member Claim Form

Dental
Delta Dental Mobile App
Maximizing Your Dental Benefits
Learn What Your Dental Score Is

Vision
Surency Reimbursement Form
Surency Mobile App

Short Term Disability
Short Term Disability Claim Form
Physician's Statement Form
Teleguard Instructions and Authorization Form

Guardian Life Insurance

Aflac
Aflac Information

3-1 Supplemental Plan
3-1 Supplemental Plan Information

LegalShield
Informational Video for LegalShield

Flexible Spending/Dependent Care (2020 Benefit Year)
Flex Web Site User Guide
Flex Card Overview
Flex Eligible Expenses
Flex Reimbursement Claim Form

Flexible Spending/Dependent Care - SURENCY effective 01/01/2021
Surency Flex User Guide
Reimbursement Claim Form

Annuity Plan

About Your 403b Plan
Tax Sheltered Annuity Plan Form

Other Links
Wellness Incentive Forms
Withdrawal of KPERS account
Derby Education Foundation Information
Derby Education Foundation Payroll Deduction Form

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