HR Documents, Forms and Schedules
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FY 2022 Performance Appraisal Forms
FY 2022 performance review will be due to Human Resources by Friday, November 18, 2022.
Position Content Document Forms
Reimbursement for remote access to systems
- Policy
- Remote access monthly reimbursement certificate
- Remote access conference reimbursement certificate
Benefit Plans 2024
- 2024 Employee Benefits Guide
- 2024 BCBS Medical and Dental OE Presentation
- 2024 Wex Flexible Spending OE Presentation
- 2024 Guardian Critical Incident Accodent - Hospital - Illness OE Presentation
- 2024 Allstate Identity Theft Protection OE Presentation
Medical
- 2024 Employee Benefits Guide
- 2024 BCBS PPO Enrollment Guide
- 2024 BCBS PPO HMO Enrollment Guide
- 2024 BCBS HMO how to find a doctor
- 2024 BCBS SBC PPO_01-01-2024 to 12-31-2024_2016-01-01
- 2024 BCBS SBC BAHMO_01-01-2024 to 12-31-2024_2016-01-01
- 2024 BCBS SBC HMO Ill_01-01-2024 to 12-31-2024_2016-01-01
Dental
Vision
Flexible Spending
Life Insurance and Disability
Other Options
- 2024 Allstate Identity Theft Protection kit
- 2024 Guardian CI Acc CIll Hosp- 2024 Enrollment kit
- 2024 Pet Benefit Solutions kit
- 2024 Transit CT Form
- 2024 Transit DC Form
- 2024 Transit IL Form
- 2024 Transit PA and Reimbursement form
- 2024 Transit Parking w Reimbursement Form
- 2024 Benefits Summary
- 2024 Benefit Contacts
- 2024 Benefits Election Form
- 2024 Medical Waiver form fillable
- 2024 Notice of Electronic Distribution of Benefit Documents
- AIP Enrollment form.pdf_fillable
- BCBS Life Insurance and Disability Enrollment Form Fillable
- BCBS enrollment form-fillable
- Guardian CI Acc CIll Hosp- Enrollment form fillable
- Wex FSA enrollment form fillable
2024 Benefit Plan Documents
Resources
Benefit Plans 2023
- 2023 Benefits Guide.pdf
- 2023 Benefits Summary
- 2023 OE BCBS BlueCare Dental Presentation
- 2023 OE Wex Flexible Spending Account Presentation
- 2023 OE Guardian Critical Incident Acc Hosp Ill Presentation
- Guardian CI Claim form Process Options - ACC CI HI
- 2023 OE Allstate Identity Protection Presentation
Health Plans
- 2023 BCBS PPO SBC
- 2023 BCBS HMO IL SBC
- 2023 BCBS BA HMO SBC
- 2023 BCBS HMO how to find a doctor
- 2023 BCBS BlueCare Dental
- 2023 EyeMed Vision Kit
- 2023 WEX - FSA and Dependent Care Enrollment Kit
Other Plans
- 2023 BCBS - Life Insurance Enrollment Kit
- 2023 BCBS - Life AD and D
- 2023 BCBS - Supplemental Life
- 2023 BCBS - Short Term Disability
- 2023 BCBS - Long Term Disability
- 2023 Guardian Critical Incident Plans - Enrollment Kit
- 2023 Pet Benefit Solutions
- 2023 Transit CT Form
- 2023 Transit DC Form
- 2023 Transit IL Form
- 2023 Transit PA and Reimbursement form
- 2023 Transit Parking w Reimbursement Form
Resources
- 2023 BCBS - EAP Employee Assistance Program Disability Resource Services
- 2023 BCBS - Beneficiary Resource Services
- 2023 BCBS - Travel Resource Services
Benefit Plan Documents 2023
Benefit Plans 2022
Medical
- 2022 BCBS PPO/HMO Enrollment Guide
- 2022 BCBS PPO Enrollment Guide
- 2022 BCBS PPO Certificate
- 2022 BCBS BA HMO SBC
- 2022 BCBS BA HMO Certificate
- 2022 BCBS BA HMO Vision Certificate
- 2022 BCBS HMO SBC IL
- 2022 BCBS HMO IL Certificate
- 2022 BCBS HMO IL Vision Certificate
- 2022 BCBS PPO SBC
- BCBS RXSS Lower Costs Flier 05 18 22
- BCBS RXSS Member FAQ BCBSIL 05 18 22
Dental
Vision
Flexible Spending Account
Life Insurance 2022
- 2022 BCBS Life and Disability Enrollment Kit
- 2022 BCBS Evidence of Insurability form
- 2022 BCBS Beneficiary Resource Services
- 2022 BCBS Life Disability Resource Services EAP
- 2022 BCBS Long Term Disability Insurance Plan
- 2022 BCBS Supplemental Life Insurance
- 2022 BCBS Group Term Life Insurance and AD and D Plan
- 2022 BCBS Short Term Disability Insurance Plan
- 2022 BCBS Life Travel Resource Services
Other Benefits
- Guardian CI 2022 05 Enrollment_Kit_
- 2022 Pet Benefit Solutions Kit
- Allstate Identity Protection Pro-Plus-Paper Enrollment 2021 08 form
- DC - Transit Form 2022
- IL - Transit Form 2022
- CT - Transit Form 2022
- PA - Transit Form 2022
- Parking Form and Reimbursement Form - All Locations
Retirement Plan
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- Retirement Plan Summary Plan Description SPD TIAA 2020
- 2022 TIAA Fee Disclosure Notice Plan_Investment_Notice 07 12
2022 Benefit Plan Documents
- 2022 Notice of Electronic Distribution of Benefit Documents
- 2022 Summary Plan Document Wrap
- 2022--Cafeteria-Plan-Summary-Plan-Description
- 2020 Creditable Coverage - Medicare Part D Notice for 2021
- 2021 Benefit Plans Summary Annual Report SAR
Recruitment
Schedules
Other Human Resources links on Support
Staff Change Form (new hires, promotions, terminations etc...)