BENEFITS AND FORMS - Derby Public Schools

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2017-2018 CLASSIFIED PAYROLL DATES

3-1 Supplemental Plan

BENEFITS AND FORMS

Effective Dates:
Deductible Year 1/1/18 - 12/31/18
Flex Spending Effective 1/1/18 - 12/31/18
Insurance Coverage 2/1/18 - 1/31/19

Website and Enrollment Information
2018 Benefit Guide
Online Enrollment/Change of Benefits (Infinityhr.com)
Open Enrollment Screen Shots

Summary Plan Documents
Open Network $1500 Deductible
Open Network $3000 Deductible
Open Network $5000 Deductible
Open Network $2700 Deductible
Open Network $6000 Deductible

Wesley Preferred $1500 Deductible
Wesley Preferred $3000 Deductible
Wesley Preferred $5000 Deductible
Wesley Preferred $2700 Deductible
Wesley Preferred $6000 Deductible

Prescription for AETNA
Prescription Drug List 2018
Here's how to get your specialty drugs through Aetna Health Insurance effective 2/1/2018

Dental
Delta Dental Mobile App

Vision
Surency Reimbursement Form
Surency Mobile App

Short Term Disability
An easier way to submit your STD claim
Short Term Disability Claim Form

Lincoln Life Insurance
Change of Name or Beneficiary Form
Lincoln Privacy Practices Notice

Aflac
Aflac Information

3-1 Supplemental Plan
3-1 Supplemental Plan Information

Flexible Spending/Dependent Care
Guide to Logging into your FSA account
**NEW**Website change notification
Eligible Product List for FSA card
FSA Reimbursement Form
FSA Qualifying Event Change Form
**NEW**Flex/Dependent Care has a mobile app

Annuity Plan
About Your 403b Plan

Other Links
Learn What Your Dental Score Is
Wellness Incentive Forms
Withdrawal of KPERS account

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