Benefit Forms

Benefit Documents:

The documents explaining benefit coverage and brochures detailing specific aspects of coverage are available on this site.

Group Health and Group Dental coverage; Educators Health Alliance (EHA) via Blue Cross Blue Shield.

• EHA overview of your Health Care; Prescription Drug Beneifts
• EHA Gastroprotective NSAID Preauthorization program
• EHA Theraputics Specialty Pharmacy
• EHA The use of Generics
• EHA Overview of Dental Benefits
• EHA Overview of Health Care Benefits
• EHA Health Care Reform Benefits for Preventative Services
• EHA The Blue Card program
• EHA Specialty Drug List

Group Term Life Insurance; Madison National Life Insurance Company

• Certificate for Life Insurance

Group Disability Insurance; Madison National Life Insurance Company

• Certificate for Disability Insurance

Nebraska Public Employees Retirement System (NPERS)

• Member handbook – School Employees Retirement System

403b Plan

• 403b Information

Flexible Spending Accounts

• FSA Flyer
• FSA Card Flyer

 Benefit Forms:

The following enrollment forms are available for employees that meet the eligibility requirements as established by the District within the confines of each specific benefit plan document.

Group Health and Group Dental

• Group Health and Dental Enrollment Form

Group Term Life Insurance; Group Disability Insurance

• Life Insurance Enrollment form

403(b)

• 403b-Enrollment form

Flexible Spending Account

• FSA Enrollment Form