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
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
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 Flex Spending Account 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
Payroll Forms
Check by Mail - authorization form for Simpson to mail your wages
Federal W-4
Iowa W-4
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.
Contact Simpson College
800-362-2454 (toll-free)
or
515-961-6251 (locally)
Admissions:
800-362-1624 (toll-free)
or
515-961-1624 (locally)
Admissions office hours are 8 a.m. to 4:30 p.m. Mon through Fri
