•  Cigna Health Plan Book  (2022)

• Delta Dental Book (2023)

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

• Standard Basic Life Insurance Certificate 

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

• 2023 Summary Benefit Comparison  (SBC) 900 Deductible 

• 2023 Summary Benefit Comparison (SBC) 2000 Deductible 

• 2023 Summary Benefit Comparison (SBC) 4000 Deductible 

• 2023 Summary Benefit Comparison (SBC) High Deductible Health Plan (HDHP) 

• 2022 Summary Benefits Comparison (SBC) 900 Deductible 

• 2022 Summary Benefits Comparison (SBC) 2000 Deductible 

• 2022 Summary Benefits Comparison (SBC) 4000 Deductible

• 2022 Summary Benefits Comparison (SBC) High Deductible Health Plan (HDHP) 

• Caremark Drug Formulary (Active Employees)  Beginning January 1, 2022 

• Caremark Specialty Drug Formulary (Active Employees) Beginning January 1, 2022

VOLUNTARY BENEFIT INFORMATION

• Voluntary Benefits Brochure (updated 9/2022)

• Disability - Short/Long Term Disability Book (updated 12/2021)

• Disability -  Maternity guide Maternity Guide  (Short Term disability)

• Vision - VSP Vision Benefits Flyer (updated for 2023)

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

• Life - Standard Voluntary Life Certificate

• Ambulance -  MASA Member Service Agreement

PREMIUM RATES & CALCULATORS

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

• 2022/2023  Life Insurance Premium Rates

• Voluntary Life Rate Grid (The Standard)

• Disability Premium Calculator

• Voluntary Benefits Brochure (Vision Rates)

• 2022/2023 Manual Rate Calculator (Full-time)

• 2022/2023 Manual Rate Calculator (AWEC/TP01)

• 2022/2023 Manual Rate Calculator (Part-time)

• 2022/2023 Rate Calculator - Full time permanent 

•  2022/2023 Rate Calculator - Part time permanent 

• 2022/2023 Rate Calculator - FT AWEC/TP01 

APPLICATION & ENROLLMENT

• Active Benefits Application  (Health, Dental and Basic Life)

• Voluntary Benefits Application (Vision & Disability) Updated 9/2022))

• Voluntary Life Application ( 2021)

• MASA Ambulance Application  (updated 7.2022)

• 2023 Flexible Benefit Election Form 

• 2022 Flexible Benefits Election Form 

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

• Health Savings Account Election Form (updated 2/2023)

• Long Term Disability Application Link

OTHER FORMS

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

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

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

• 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)

• Short Term Disability Claim Form The Standard Company     1-800-368-2859

• Long Term Disability Claim Form The Standard Company     1-800-368-1135

• 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