•  Cigna Health Plan Book  (2023)

• Delta Dental Book (2024)

• Delta Dental Benefit Summary  (2023) 

• Standard Basic & Voluntary Life Guide (12/2021)

• Standard Basic Life Insurance Certificate (10/2023) 

• Flexible Benefits Book (updated 1/1/2023)

• 2024 Summary Benefit Comparison (SBC) 900 deductible 

• 2024 Summary Benefit Comparison (SBC) 2,000 deductible 

• 2024 Summary Benefit Comparison (SBC) 4,000 deductible 

• 2024 Summary Benefit Comparisions (SBC) High Deductible Health Plan (HDHP)  

• Caremark CVS Standard Medical Formulary  (Jan 1, 2024)

• Caremark CVS Specialty Medication Formulary  (Jan 1, 2024)

VOLUNTARY BENEFIT INFORMATION

• Voluntary Benefits Brochure (updated 12/2023)

• Disability - Aflac Benefit Summary   (Eff 1/1/2024)

• Disability - Aflac Benefit Summary TP01 (eff 1/1/2024)

• Disability - Aflac Short Term Disability (STD) Certificate

• Disability - Aflac Long Term Disability (LTD) Certificate 

• Disability -  learn.aflac.com/stateofwyoming 

• Disability - If you are enrolled in Long  Term Disability you are able to participate with  Neuroflow mental wellbeing tool.  Registration Information. 

• Vision - VSP Vision Benefit Flyer  (effective 1/2024)

• Life - Standard Basic & Voluntary Life Benefit Guide (9/2023) 

• Life - Standard Voluntary Life Certificate (10/2023)

• Ambulance -  MASA Member Service Agreement

• Ambulance - MASA Claim Instructions 

• Ambulance - MASA mobile app info 

• NEW 1/1/24- MetLife Pet Insurance Book  (direct pay benefit, not payroll deducted)

• NEW 1/1/24- MetLife Pet Insurance Overview  (includes webinar info)

• NEW 1/1/24- MetLife Pet Insurance Enrollment Guide 

• NEW 1/1/24 - Metlife Pre-Existing information 

PREMIUM RATES & CALCULATORS

• 2024 Active & Cobra Rates  (Health, dental)

• 2022/2023 Active & Cobra Rates (Health, dental)

• 2022/2023  Life Insurance Premium Rates

• Voluntary Life Rate Grid (The Standard)

• Disability Manual Premium Calculator (Aflac eff 1/1/24)

• Disability Premium Calculator (The Standard)

• 2024 Manual Rate Calculator (Full-time)

• 2024 Manual Rate Calculator (AWEC/TP01)

• 2024 Manual Rate Calculator (Part-time)

• 2023/2024 Rate Calculator - Full time permanent 

•  2023/2024 Rate Calculator - Part time permanent 

• 2023/2024 Rate Calculator - FT AWEC/TP01 

APPLICATION & ENROLLMENT

• Active Benefits Application  Health, Dental, Basic Life (eff 1/1/24)

• Voluntary Benefits Application (Vision & Disability) Updated 12/2023))

• Voluntary Life Application ( 2021)

• MASA Ambulance Application  (updated 7.2022)

• 2024 Flexible Benefit Election Form 

• Flex Benefits Change Form (used for mid year changes)

• Health Savings Account Election Form (updated 7/2023)

• Basic Life "underwriting" Application Link

OTHER FORMS

• Medical Reimbursement & Dependent Day Claim Form (Updated 1/2022)

   Flex deadline is every Friday.  Reimbursements are payable the 2nd Thursday after deadline. 

• Qualifying Event Matrix (updated 12/2022) What benefits can be changed based on a qualifying event.

• Caremark Rx Claim Form

• Caremark Rx Mail Order Form

• Delta Dental Claim Form Used to send your claim to Delta Dental when your provider is non-participating.

• Vision Out of Network Reimbursement Claim Form (2022)

• Disability Claim - How to file a claim  AFLAC For disability dates 1/1/24 and after

Customer service 800-206-8826 available 1/2/2024

•  Short Term Disability Claim Form The Standard Company     1-800-368-2859 Do not use after 12/31/23

• Long Term Disability Claim Form The Standard Company     1-800-368-1135 Do not use after 12/31/23

• Cigna Claim Form Used to send medical claims to Cigna.

• Evidence of Insurability for Standard Life Insurance

• HIPAA Privacy Authorization Form

• Update Life Insurance Beneficiary Form 

PRIOR YEARS INFORMATION