91´«Ã½

FY 2022 91´«Ã½ Performance Appraisal Forms

FY 2022 performance review will be due to Human Resources by Friday, November 18, 2022.

• Performance Review Exempt 2022 form
• Performance Review Non Exempt 2022 form

Position Content Document Forms

• Exempt Position
• Non-Exempt Position
• Position Evaluation Request

Reimbursement for remote access to 91´«Ã½ systems

• Policy
• Remote access monthly reimbursement certificate
• Remote access conference reimbursement certificate

Benefit Plans 2025

• 2025 Employee Benefits Guide
• 2025 Benefits Summary

Medical

• 2025 BCBS BAHMO SBC 91´«Ã½ 01-01-2025-12-31-2025
• 2025 BCBS HSA SBC (updated v 2024-12)
• 2025 OE Presentation BCBS Medical
• 2025 BCBS BA HMO PPO and HDHP HSA IL Enrollment Guide
• 2025 BCBS PPO and HDHP HSA Enrollment Guide

Dental

• 2025 BCBS Dental High PPO Plan (HL) EE
• 2025 BCBS DENTAL LOW PPO Plan (HL) EE
• 2025 OE Presentation BCBS Dental

Vision

• 2025 EyeMed - Vision Enrollment Kit

Flexible Spending

• 2025 EBC - FSA Enrollment Kit
• 2025 OE Presentation FSA

Health Savings Account

• 2025 EBC - HSA Enrollment Kit
• 2025 BCBS HSA SBC 01-01-2025 - 12-31-2025
• 2025 OE Presentation HSA

Life Insurance and Disability

• 2025 BCBS LIFE DIS ENROLLMENT KIT
• 2025 BCBS EVIDENCE OF INSURABILITY EOI FORM

Other Options

• 2025 Allstate Identity Theft Protection
• 2025 ALLSTATE ID PROTECTION ENROLLMENT KIT
• 2025 Travel Accident Insurance CHUBB w 91´«Ã½ Travel and Medical Assistance Card 2024-25
• 2025 Guardian CI - Enrollment Kit 00543094
• 2025 Pet Benefit Solutions kit
• 2025 Transit CT Form
• 2025 Transit DC Form
• 2025 Transit IL Form
• 2025 Transit PA and Reimbursement form
• 2025 Transit Parking w Reimbursement Form

2025 Benefit Plan Documents

• 2025 Retiree Plan Contact Info
• 2024 Creditable Coverage Medicare Part D Notice 91´«Ã½ for 2025
• 2024 ERISA Plan Document SPD 01-01-22
• Retirement Plan Summary Plan Discription spd 91´«Ã½ TIAA 2020

Resources

• 2025 BCBS DISABILITY RESOURCE SERVICES
• 2025 BCBS BENEFICIARY RESOURCE SERVICES
• 2025 BCBS Travel Resource Services
• 2025 91´«Ã½ Policy Manual
• 91´«Ã½ Organization Chart FY 2025

Retiree Plans

• 2025 BCBS MAPD 01Plan
• 2025 BCBS MAPD 02 Summary of Benefits
• 2025 BCBS MAPD 03 Annual Notice of Change
• 2025 BCBS MAPD 04 Extra Health and Wellness benefits
• 2025 BCBS MAPD 91´«Ã½ Group Enrollment Form
• 2025 Medicare and You Handbook
• 2025 Retiree Benefits Reference Information Packet
• 2025 EBCFlex Summary Plan Description FSA-2024

Benefit Plans 2024

• 2024 Employee Benefits Guide
• 2024 BCBS Medical and Dental OE Presentation
• 2024 Wex Flexible Spending OE Presentation
• 2024 Guardian Critical Incident Accident - 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

• 2024 BCBS Dental Plans

Vision

• Eye Med Tool Kit-1

Flexible Spending

• 2024 Wex FSA enrollment kit

Life Insurance and Disability

• 2024 BCBS Life Insurance and Disability Enrollment Kit

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
• 2023 91´«Ã½ Benefits Summary Annual Report (SAR)

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

• 91´«Ã½ Cafeteria Plan Summary Plan Description
• Retirement Plan Summary Plan Description
• 2023 91´«Ã½ Retirement Plan Summary Annual Report SAR

Benefit Plans 2022

• 2022 91´«Ã½ Benefit Guide
• 2022 Benefits Summary

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

• 2022 Guardian Dental Enrollment Kit

Vision

• 2022 EyeMed Vision Benefit Summary and Kit

Flexible Spending Account

• 2022 Flex Enrollment Kit and form
• 2022 FSA Eligible Expense List

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_91´«Ã½
• 2022 Pet Benefit Solutions Kit
• Allstate Identity Protection Pro-Plus-Paper Enrollment 2021 08 form 91´«Ã½
• 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 91´«Ã½ 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 91´«Ã½ Summary Plan Document Wrap
• 2022-91´«Ã½-Cafeteria-Plan-Summary-Plan-Description
• 2020 Creditable Coverage - Medicare Part D Notice 91´«Ã½ for 2021
• 2021 Benefit Plans Summary Annual Report SAR

Recruitment

• Personnel Staffing Request Form

Schedules

2022 Holiday Schedule

2023 Holiday Schedule

2024 Holiday Schedule

Other Human Resources links on Support

2025 91´«Ã½ Employee Policy Manual

Staff Change Form (new hires, promotions, terminations etc...)

Families First Coronavirus Response Act

Training Resource Library (TRL) Video Courses