Active Employees
EVERYTHING YOU NEED AS AN EMPLOYEE
Employees' Group Insurance covers active employees with the State of Wyoming, University of Wyoming, Wyoming Community Colleges and Natrona County School District.
CONTACT INFO
BENEFIT INFORMATION AND PLAN BOOKLETS
Voluntary Benefits Brochure (updated 1/1/2019)
Short/Long Term Disability Book (updated 10/2020)
MASA Member Service Agreement (Voluntary Ambulance coverage)
2020 Summary Benefits Comparison (SBC) 1500 High Deductible Health Plan (HDHP)
2021 Summary Benefits Comparision (SBC) High Deductible Health Plan (HDHP)
PREMIUM RATES & CALCULATORS
January 2021 Manual Rate Calculator (Full-time)
January 2021 Rate Calculator (DOWNLOAD, then open in Microsoft Excel)
Standard Voluntary Life Rate Grid (benefit available 1/1/2021)
August 2020 Rate Calculator -(download, then open in Excel)
APPLICATION & ENROLLMENT
Active Benefits Application 2020 (Health, Dental and Life)
Active Benefits Application 2021 (Health, Dental and Life)
Voluntary Benefits Application (Vision & Disability)
MASA Ambulance Application ( effective 1/1/2021)
Flex Benefits Change Form (used for mid year changes)
Link to Genworth site When prompted enter: Group Name: statewy Access code: groupltc
OTHER FORMS
Medical Reimbursement & Dependent Care Claim Form (Updated 4/25/2017)
Flex deadline is every Friday. Reimbursements are payable the the 2nd Thursday after deadline.
Qualifying Event Matrix What benefits can be changed based on a qualifying event.
MedImpact Direct Rx Mail Order Form For use on prescriptions that did not go through a retail pharmacy.
MedImpact Claim Form Used for manual submission of prescription reimbursement.
Delta Dental Claim Form Used to send your claim to Delta Dental when your provider is non-participating.
Short Term Disability Insurance 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.
WEBSITE LINKS
Health Savings Account Questions Frequently Asked Questions
WEBSITE LINKS
Cigna
1-800-685-1060
Delta Dental of Wyoming
307-632-3313 or
1-800-735-3379
Vision Service Plan
1-800-877-7195
MedImpact Pharmacy
1-800-788-2949
