View and/or print forms and information sheets below by clicking on the document title.

NOTE: Life changes (e.g. marriage, birth of a child, divorce) that create an opportunity for or require a change in coverage must be reported to the Benefits Department within 30 days of the qualifying event.

2023 Benefits Open Enrollment - October 31,2022 to November 21,2022

pdf2023 Open Enrollment Information

pdf2023 Benefit Guide

pdfNew HRA FAQ

pdfNEW-HRA Reimbursement Form

 2023 MEDICAL/DENTAL COVERAGE
All basic medical plan packages include health and dental coverage options.

pdf2023 Health Plan Rates

pdfSignature Care Brochure

pdfSignature Care EPO Map

pdfDirect Imaging

pdfHealthiestYou

pdf2023 Health Savings Account vs Flexible Spending Account

pdfLab Services-Lab Corp

Magellan Rx Mail Brochure

Magellan Rx Mail Order Form

pdfMedtipster-free

pdfMRx Mobile App Client

pdfMagellan Rx Member Website Guide

pdfMRx Select Savings

pdfBeam Dental Benefit Summary

pdfBeam FAQs

 OPTIONAL SPECIALIZED COVERAGE

pdfEPIC Discount Program

 VISION PLAN

pdfVision Benefit Summary

Additional Materials

Contact Lens

Frames

Provider Network

Print ID Card

 LIFE & ACCIDENTAL DEATH/DISMEMBERMENT & SHORT AND LONG TERM DISABILITY
pdfSymetra-Beneficiary Designation Form

pdfSymetra Rate Sheet

pdfSymetra-Supplemental Life Application

pdfSymetra-Evidence of Insurability Application

pdfSymetra-Value Added Benefits

Estate Guidance
Financial Information & Resources
Legal Support
Confidential Counseling

pdfSummary of Life Benefits-PBA

pdfSummary of Life Benefits-IAFF

pdfSummary of Life Benefits-FOP

pdfSummary of Life Benefits-All Others

pdfSummary of Short Term Disability Benefits

pdfSummary of Long Term Disability Benefits

  FLEXIBLE SPENDING ACCOUNTS
Enrolled employees have pre-tax program options to assist them in managing their medical and/or childcare expenses.

pdfFlex Medical Debit Card Website

pdfFlex Medical Reimbursement Form

pdfFlex Childcare Reimbursement Form

 GENERAL NOTICES
A selection of medical health related City policies

pdfHIPPA Privacy Notice

pdfAmendment #18 Spousal COB

pdfCOBRA Notice

pdfFamily Medical Leave Information

pdfMedicare Part D Notice

pdfExchange Notice

pdfGrandfathered Health Plan Notice

pdfMedicaid & CHIP Notice

pdfWHCRA Notice

 RETIREMENT BENEFITS
Retirement plans & savings options.

pdfPERF-at-a-Glance

pdf457 Plan Lincoln Financial Group

pdf457 Nationwide Plan

 WELLNESS BENEFITS

pdfGuidelines for Healthy Lifestyle Benefit

pdfGym Club Reimbursement Form

pdfHealthy Lifestyle Reimbursement Form

pdfEmployee Assistance Program

pdfParkview EAP FAQ

pdfManaged Care Concept-Chronic Care Program

pdfManaged Care Concept-Healthy Track

pdfDaavlin Home Phototherapy Benefit

pdfWellness Benefits

Community Loan Center Of Northeast Indiana

 FEDERAL TRANSPARENCY in COVERAGE RULE

www.aga-tpa.com/machine-readable-files 

This link leads to the files that are made available in response to the Federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to access and analyze data more easily.