Human Resources

Forms & Resources

On this site you may access forms which are available to be viewed and printed. To access any of the following forms, click on the form you are interested in, and then use the print feature in the application it is displayed in. To view PDF files you need to get Adobe Acrobat Reader.

Open Enrollment Checklist

2012-2013 Open Enrollment Checklist

Medical

2012-2013 Health Insurance Rates

2012-2013 Health Plan Comparison Plan A - Plan B

2012-2013 Health Plan Comparison Plan C - Plan HDHP/HSA

Enrollment Form
     Use this form to change plans at open enrollment 

Membership Change Form
     Use this form to make address changes, name changes, cancel
     coverage, or to add dependents

Preferred Provider Form - 
     Use this form with Plan B and Plan C

2012-2013 Plan C / HSA Reimbursement

2012-2013 Medical Waiver
     All employees who choose the medical waiver need to complete a new
     form yearly

Wellmark Preventive Services covered under The Affordable Care Act

HSA Payroll Deduction Change Form

HSA Frequently Asked Questions

Glossary of Terms

Dental/Vision

2012-2013 Dental/Vision Rates
     Includes Plan Summary

Dental/Vision Enrollment Form
    
  Use this form to make address changes, name changes,cancel
      coverage, add dependents, or to change plans at open enrollment

Dental / Vision Provider Link

 VSP Out of Network Claim Form
       
Use this form if you have an out of network provider

  Flexible Spending  Accounts

2012-2013 125 Flex Spending Account Election Form
    
Use this form at open enrollment to make changes to your flex spending
     accounts or to add a flex spending account

2012-2013 Flex Claim Form

2012 Flex Spending Account  Information

2012 Orthodontia Information

Flex Account Reimbursement Direct Deposit Form

Life Insurance

Life Insurance Enrollment Form
      
Use this form for new hires and to change beneficiaries

Evidence of Insurability Form
      
Use this form if you want to add additional optional coverage

Coast to Coast Vision Plan

Coast to Coast Enrollment Form/Information
    
A new enrollment is required each year of participation.

Coast to Coast Iowa Provider Directory

Tuition Remission/Exchange

Tuition Remission Application

Tuition Exchange Application

Payroll Forms

Direct Deposit 

           Check by Mail - authorization form for Simpson to mail your wages

          Federal W-4

          Iowa W-4

          I-9

Name Change - Apply to the Social Security Administration for a new card,
provide HR with a copy of the new card to make the change.

SSA Name Change

Last Updated: 5/14/12