Payroll/Benefits Forms and Information
Direct Deposit Form
Nebraska Public Employers Retirement System - NPERS
403(b) PLAN
HEALTH INSURANCE
- BCBS Rates 2022-2023
- BCBS HDHP Rates 2022-2023
- BCBS Enrollment Form
- Preventative Services
- BCBS EHA Certificate of Coverage and Benefits Coverage $650 Plan
- BCBS Schedule of Benefits Summary $650 Plan
- BCBS EHA Certificate of Coverage and Benefits Coverage $3800 HDHP Plan
- BCBS Schedule of Benefits Summary $3800 HDHP Plan
- Health Insurance Marketplace Coverage Notice
DENTAL INSURANCE
- Dental Benefits Certificate-Summary of Coverage Option 2
LIFE INSURANCE and LONG TERM DISABILITY (LTD)
- Certificate of Insurance_Employees 20000 per year or more
- Certificate of Insurance Employees 15000 less than 20000 per year
- Certificate of Insurance_Employees 10000 less than 15000 per year
- Certificate of Insurance_Employees less than 10000 per year
- LTD/Life Insurance Benefit Form
- Long Term Disability- Classified
- Long Term Disability- Certified
SELECT FLEX
VISION INSURANCE
W-4 FORMS