Calendar Menus Work at 27J

Insurance Premium Rates and Employee Cost

Monthly Employee Insurance Premium Rates 7/1/17 to 6/30/18

SD27J Premium rate sheet for 07-01-17 to 06-30-18 1.pdf 16.87 KB (Last Modified on April 6, 2017)

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Medical Insurance

Kaiser Manage Your Care Online

Kaiser Manage Your Care Online.pdf 213.17 KB (Last Modified on November 7, 2017)

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Kaiser Care Options

Kaiser Care_Options_Member_Flier_Mountain_Northern_Southern_Colorado.pdf 82.42 KB (Last Modified on November 7, 2017)

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Medicare Creditable Non-Creditable Coverage

Medicare Creditable Coverage Notice for SD27J - September 2017.pdf 478.72 KB (Last Modified on September 28, 2017)

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Insurance Enrollment and Change Form

SD27J Insurance Enrollment and Change Form - Modified February 2018.pdf 166.84 KB (Last Modified on February 23, 2018)

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Waiver of Group Insurance Benefits Form

SD27J Waiver of Group Insurance Benefits Form 20180131.pdf 119.02 KB (Last Modified on February 7, 2018)

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Kaiser HDHP Summary of Benefits

School District 27J HDHP 5000 SBC.pdf 923.06 KB (Last Modified on July 17, 2017)

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Kaiser DHMO Summary of Benefits

School District 27J DHMO 2500 SBC.pdf 933.9 KB (Last Modified on July 17, 2017)

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Kaiser ACDC Summary of Benefits

School District 27J ACDC SBC.pdf 942.39 KB (Last Modified on July 17, 2017)

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Kaiser Permanente 2017 Sample Fee List

2017 Kaiser Sample Fee List.pdf 491.26 KB (Last Modified on May 15, 2017)

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Kaiser Complaint Form

Complaint Form for 27J employees to use when they have issues with Kaiser.doc 58.50 KB (Last Modified on October 8, 2014)

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IRS Publication 502

IRS Publication 502 Medical and Dental Expenses for 2017.pdf 1.46 MB (Last Modified on April 5, 2018)

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Dental, Vision and Employee Assistance Program

Dental Claim form front page

Dental Claim Form - Front side.pdf 61.25 KB (Last Modified on July 25, 2014)

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Dental Claim form back page

Dental Claim Form - Back side.pdf 10.30 KB (Last Modified on July 25, 2014)

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Dental Plan Summary of Benefits

District 27J Dental Plan Summary of Benefits.doc 27.00 KB (Last Modified on June 16, 2015)

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Dental Plan Booklet

SD27J Dental Plan Doc_FINALDRAFT July 2015.pdf 358.00 KB (Last Modified on April 13, 2015)

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Vision Plan Summary

Vision 2016-2017.pdf 44.10 KB (Last Modified on June 15, 2016)

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Employee Assistance Program Flyer

EAP Benefit Summary.pdf 1.69 MB (Last Modified on November 1, 2017)

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Employee Assistance Program - Life After Cancer

EAP - Monthly Awareness Life After Cancer ARFL.pdf 368.44 KB (Last Modified on June 23, 2017)

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Life/AD&D Insurance with The Standard Insurance Company

Life Insurance Enrollment Form for The Standard

Life Insurance Enrollment Form for The Standard.pdf 102.20 KB (Last Modified on July 25, 2014)

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Flexible Spending Accounts

Flex Enrollment Form 2017-2018

School District 27J 2017 2018 Flex Enrollment Form Final.pdf 246.64 KB (Last Modified on June 23, 2017)

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Flex Enrollment Booklet 2017-2018

School District 27J FSA Guide July 2017.pdf 2.03 MB (Last Modified on June 23, 2017)

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Flexible Spending Change/Termination Form

Flexible Spending Account Termination or Change of status Form.pdf 54.89 KB (Last Modified on July 7, 2016)

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Dependent Care Reimbursement Claim Form

SD27J HealthSmart FSA Dependent Care Reimbursement Claim Form 2017.pdf 376.48 KB (Last Modified on July 17, 2017)

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Health Care Reimbursement Claim Form

SD27J HealthSmart FSA Health Care Reimbursement Claim Form 2017.pdf 421.4 KB (Last Modified on July 17, 2017)

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Health Savings Account Paycheck Contribution Form

Health Savings Account Paycheck Contribution Form - March 2018 .pdf 511.35 KB (Last Modified on March 9, 2018)

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Health Savings Accounts - Frequently Asked Questions

Health Savings Accounts Frequently Asked Questions for SD27J 2017 2018 20180319.doc 137 KB (Last Modified on April 5, 2018)

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HSA Allowable & Non-Allowable Expenditures

HSA Qualified and Non Allowable Medical Expenses per 2015 HSA Road Rules.pdf 1.65 MB (Last Modified on June 28, 2016)

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IRS Publication 969 Health Savings Accounts

IRS Publication 969 Health Savings Accounts 2017.pdf 1.37 MB (Last Modified on April 5, 2018)

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Health Savings Account Paper Application

HSA Bank Paper Application and Eligibility Form for SD27J Nov 16 2017.pdf 568.4 KB (Last Modified on April 5, 2018)

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H S A Beneficiary

HSA Beneficiary Flyer.pdf 749.93 KB (Last Modified on February 13, 2018)

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H S A Investment Options

HSA Investment Options.pdf 128.75 KB (Last Modified on February 13, 2018)

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TEMPORARY LEAVE BANK

2017-2018 Certified Temporary Leave Bank Election Form

2017-2018 Certified Temporary Leave Bank election form.pdf 198.11 KB (Last Modified on August 24, 2017)

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2017-2018 Classified Temporary Leave Bank Election Form

2017-2018 Classified Temporary Leave Bank election form.pdf 116.88 KB (Last Modified on June 23, 2017)

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School District 27J Retirement Programs

Retirement Plans

SD27JRetirementPlans.pdf 73.92 KB (Last Modified on September 19, 2016)

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Address/Name Change

PERA Form

Address Change - PERA.pdf 227.74 KB (Last Modified on January 23, 2017)

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Insurance Enrollment/Change Form

Address Change Insurance Form 2018.pdf 778.11 KB (Last Modified on February 23, 2018)

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Human Resources

Insurance Premium Rates and Employee Cost

Medical Insurance

Dental, Vision and Employee Assistance Program

Life/AD&D Insurance with The Standard Insurance Company

Flexible Spending Accounts

Health Savings Account - HSA Bank

TEMPORARY LEAVE BANK

School District 27J Retirement Programs

Address/Name Change

Address

Phone

Fax