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Insurance Premium Rates and Employee Cost

Monthly Employee Insurance Premium Rates 7/1/20 to 6/30/21

27J Schools Premium rate sheet for 07-01-20 to 06-30-21.pdf 199.47 KB (Last Modified on April 29, 2020)

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Medical Insurance

Insurance Enrollment and Change Form

27J Schools Insurance Enrollment and Change Form - Modified February 2019.pdf 165.36 KB (Last Modified on April 15, 2019)

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Waiver of Group Insurance Benefits Form

Waiver of Group Insurance Benefits Form 20190211.pdf 121.41 KB (Last Modified on February 11, 2019)

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Kaiser HDHP Summary of Benefits

27J HDHP 2020-2021 Summary of Benefits.pdf 937.69 KB (Last Modified on May 4, 2020)

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Kaiser DHMO Summary of Benefits

27J DHMO 2020-2021 Summary of Benefits.pdf 934.61 KB (Last Modified on May 4, 2020)

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Get Registered on KP.org

Kaiser Registration Flyer.pdf 427.6 KB (Last Modified on June 21, 2019)

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Age-appropriate Preventive Screening Guidelines for men and women

Preventive Screening Guidelines.pdf 698.88 KB (Last Modified on February 7, 2019)

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A little prevention goes a long way

A little prevention goes a long way.pdf 2.02 MB (Last Modified on February 7, 2019)

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Understanding Preventive Care

Understanding Preventive Visits.pdf 45.3 KB (Last Modified on February 7, 2019)

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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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Kaiser Permanente 2020 Sample Fee List

Kaiser Sample fee list 2020.pdf 824.83 KB (Last Modified on October 19, 2020)

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Medicare Creditable Non-Creditable Coverage

Medicare Creditable Coverage Notice for SD27J - August 2020.pdf 554.67 KB (Last Modified on August 30, 2020)

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Kaiser Complaint Form

2019 Complaint Form for 27J employees to use when they have issues with Kaiser.pdf 189.05 KB (Last Modified on April 9, 2019)

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IRS Publication 502

IRS Publication 502 - 2019.pdf 1.46 MB (Last Modified on October 19, 2020)

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Dental and Vision

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

27J Schools Dental Plan Summary of Benefits.pdf 568.3 KB (Last Modified on June 21, 2019)

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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

27J Schools 2020-2021 VSP 1.pdf 572.22 KB (Last Modified on September 8, 2020)

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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 - 2019 .pdf 175.57 KB (Last Modified on February 11, 2019)

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Flexible Spending Accounts

Flex Enrollment Form 2020-2021

27J Schools 2020 FSA Enrollment Form.pdf 200.38 KB (Last Modified on May 4, 2020)

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Flex Enrollment Booklet 2020-2021

27J Schools 2020 FSA Guide.pdf 1,014.37 KB (Last Modified on May 4, 2020)

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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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IRS Publication 502

IRS Publication 502 - 2019.pdf 1.46 MB (Last Modified on October 19, 2020)

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Health Savings Account - HSA Bank

Health Savings Accounts Frequently Asked Questions

27J Schools Health Savings Accounts - Frequently Asked Questions for SD27J - 2019-2020.pdf 411.11 KB (Last Modified on May 16, 2019)

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Health Savings Account Paycheck Contribution Form

27J Schools Health Savings Account Paycheck Contribution Form January 2020.pdf 425.66 KB (Last Modified on February 6, 2020)

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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 May 16, 2019)

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IRS Publication 969 Health Savings Accounts

IRS Publication 969 - 2019.pdf 1.38 MB (Last Modified on October 19, 2020)

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H S A Beneficiary

HSA_Beneficiary_Flyer.pdf 749.93 KB (Last Modified on May 16, 2019)

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27J Schools Retirement Programs

Retirement Plans - 401K/403B

Retirement Plans 1.pdf 120.92 KB (Last Modified on November 7, 2019)

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OMNI Updates

Inside_Edge-4th-Qtr-2020_72.pdf 1.79 MB (Last Modified on November 4, 2020)

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403B UA Notice

403B UA Notice 573 2021.pdf 430.24 KB (Last Modified on January 21, 2021)

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