Payroll

Forms
I-9    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

Employee Health Coverage Application

Employee Waiver of Coverage

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

Persons Covered Total
Cost		 Employee
Cost
Employee $659.73 $  -0-
Employee/Spouse 1,415.63 755.90
Employee/1 Child 999.88 340.15
Employee/2+Children 1,157.38 497.65
Family 1,636.08 976.35

PPO Summary of Benefits

Rx Highlight Sheet - both Plans






HSA Blue PPO for Statewide Schools - Economy Option - $3,000 Deductible

Persons Covered Total Cost Employee Cost
Employee $  519.68               $   -0-
Employee/Spouse 1,107.48 587.80
Employee/1 Child 784.18 264.50
Employee/2+Children 906.63 386.95
Family 1,278.93 759.25
District Contribution
to HSA		 140.05 $-0-

HSA PPO Summary of Benefits

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

Lifemap Vision
VSP Info
Vision Summary
Vision Enrollment
Vision Waiver
 Persons Covered
Employee
Employee/Spouse
Employee/Child
Employee/Children
Family


Employee
Employee/Spouse
Employee/Children
Family
 Total Cost
$33.31
  66.62
  66.20
  96.97
128.33


  6.63
13.25
14.19
22.66 		Employee Cost
$  -0-
  33.31
  32.89
  63.66
  95.02


  -0-
   6.62
   7.56
  16.03

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