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 $1,175.75 $    -0-
Employee/Spouse 2,544.90 1,369.15
Employee/1 Child 1,791.85 616.10
Employee/2+Children 2,077.20 901.45
Family 2,944.20 1,768.45

PPO Benefit Summary
   Rates effective 9/1/26 - 8/31/27

Smart Shopper Brochure




HSA Blue PPO for Statewide Schools - Economy Option - $3,400 Deductible

Persons Covered Total Cost Employee Cost
Employee
$  916.70
   $       -0-
Employee/Spouse 1,975.25 885.80
Employee/1 Child 1,393.50 398.65
Employee/2+Children 1,613.50 583.10
Family 2,283.85 1,144.05
District Contribution
to HSA
259.05 $    -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
$38.99
  77.97
  77.49
113.51
150.20


  6.88
13.76
14.76
23.56
Employee Cost
$  -0-
  38.98
  38.50
  74.52
111.21


  -0-
   6.88
   7.88
  16.68

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