Payroll

Forms
I-9 Form  -  I-9 Supplement  -  I-9 Form Instructions
W-4 - IRS Federal Withholding Estimator
Idaho W-4 (Optional)
Direct Deposit Form
Drug Testing Policy - 300.20a
Drug Testing Policy Acknowledgement

Blue Cross  - Health Insurance
Website - MD Live Flyer

Employee Health Coverage Application

Employee Waiver of Coverage

Preferred Blue PPO for Statewide Schools - $1,000 Deductible

Persons Covered Total
Cost		 Employee
Cost
Employee $984.20 $  -0-
Employee/Spouse 2,129.90 1,145.70
Employee/1 Child 1,499.75 515.55
Employee/2+Children 1,738.55 754.35
Family 2,464.05 1,479.85

PPO Benefit Summary
   Rates effective 9/1/25 - 8/31/26

Smart Shopper Brochure




HSA Blue PPO for Statewide Schools - Economy Option - $3,300 Deductible

Persons Covered Total Cost Employee Cost
Employee $  767.40               $   -0-
Employee/Spouse 1,653.20 885.80
Employee/1 Child 1,166.05 398.65
Employee/2+Children 1,350.50 583.10
Family 1,911.45 1,144.05
District Contribution
to HSA		 216.80 $-0-

HSA PPO Benefit Summary

Delta Dental
Website
Area PPO Providers
Area Premier Providers
General Benefit Plan Summary
Enrollment Form

Ameritas Vision
VSP Info
Vision Enrollment
 Persons Covered
Employee
Employee/Spouse
Employee/Child
Employee/Children
Family


Employee
Employee/Spouse
Employee/Children
Family
 Total Cost
$37.49
  74.97
  74.51
109.14
144.42


  6.63
13.25
14.19
22.66 		Employee Cost
$  -0-
  37.48
  37.02
  71.65
106.93


  -0-
   6.62
   7.56
  16.03

Public Employees Retirement System of Idaho (PERSI)
Website
Beneficiary Designation
Choice 401k Forms and Information