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.

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

 

 City of Fort Wayne Employee Benefits Guide

 

PHP INFORMATION and FORMS 
pdfPHP Welcome Letter

pdfPHP Coordination of Benefits Form - Email completed forms to This email address is being protected from spambots. You need JavaScript enabled to view it. or fax to 260-436-7235.

pdfPHP Freedom Network Hospital Map

Click Here to Search For a Provider (Effective 1/1/25)  
      - 
Select "PHP Freedom Encore Combined" from the Network drop-down menu to search for in-network providers.

pdfPHP Member Portal

pdfPHP Mobile App

pdfHRA FAQ - PHP

pdfHRA Reimbursement Form PHP

pdfGuidelines for Healthy Lifestyle Benefit

pdfGym Club Reimbursement Form PHP 

pdfHealthy Lifestyle Reimbursement Form PHP 

 


MEDICAL/DENTAL COVERAGE

All basic medical plan packages include health and dental coverage options.

pdfMedical Summary Plan Description

pdf2025 Health Plan Rates

pdfDirect Imaging

pdfLab Services-Lab Corp

pdfPrime Therapeutics

 

 OPTIONAL SPECIALIZED COVERAGE

pdfEPIC Discount Program

 

VISION PLAN

pdfVision Benefit Summary

pdfUHC Vision Provider Network

pdfVision Savings at Warby Parker

pdfVision Benefits for Children and Maternity

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

pdfHealth Savings Accounts vs Flexible Spending Accounts

pdfFlex Medical Website PHP

pdfPHP Flex Reimbursement Form

pdfFlex Childcare Reimbursement Form

pdfUMB HSA Enrollment Guide

 pdfQuick Guide to HSAs

pdfTop HSA Questions

 pdfSaving and Spending HSA Dollars


HEALTH REIMBURSEMENT ACCOUNT

pdfHRA FAQ

pdfHRA Reimbursement Form PHP


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
Click on "RETIREMENT BENEFITS" above for informative video.
Retirement plans & savings options.

pdfPERF-at-a-Glance

pdf457 Plan Lincoln Financial Group

pdf457 Plan Nationwide

 

WELLNESS BENEFITS

pdfGuidelines for Healthy Lifestyle Benefit

pdfGym Club Reimbursement Form PHP (Submissions after 12/20/24)

pdfHealthy Lifestyle Reimbursement Form PHP (Submissions after 12/20/24)

pdfEmployee Assistance Program

pdfParkview EAP FAQ

pdfWellness Benefits 

pdfCommunity Loan Center of Northeast Indiana

 

UNUM CERTIFICATES OF COVERAGE
Voluntary Supplemental Employee Benefits

pdfUNUM Accident Certificate of Coverage

pdfUNUM Critical Illness Certificate of Coverage

pdfUNUM Hospital Indemnity Certificate of Coverage

 

 ATLANTIC AMERICAN 
Voluntary Whole Life Coverage

pdfAtlantic American Benefit Summary

 

FEDERAL TRANSPARENCY in COVERAGE RULE

https://services.phpni.com/machine-readable-files/files/phpni/phpni