Dental Enrollment Form
Coordination of Benefits Form
Benefit Summary Plan
Summary Plan Description
ACH Authorization
Claim Reimbursement
QuickStart Guide
Dental Amendment 2022

2023 FSA (Medical and Dependent) Enrollment Form

Reimbursement/Claim Form

2023 Max Limit Contributions:

Medical - $3,050
Dependent Care - $5,000

*FSA works as a "use it or lose it" account, meaning any funds that are not spent by the end of the calendar year will be lost.
*Anyone can participate in the FSA plan, even if not covered under a school-sponsored insurance plan. 
*If you have both an HSA and FSA Medical account, you may only use your FSA account for Dental and Vision. 
*Contributions are made tax-free! 

2023 Health Insurance Rates
HSA Summary of Benefits 
Value Plan Summary of Benefits
Mayo Network Complete Health Information
HSA Plan ONLY - Preventative Drug List
Enrollment/Change/Cancellation Form
2023 Health Insurance Presentation with Mark Beltz 

Medica CompleteHealth 
Medica Choice Passport

2023 HSA Enrollment Form

Reimbursement/Claim Form

2023 Max Limit Contributions: 

Single - $3,850
Family - $7,750
55+ Catch Up Contribution - $1,000

*There is no limit to when you can use your funds. Unspent funds are transferred year to year.
*Must be enrolled in a HDHP (High Deductible Health Plan), such as the Medica HSA. 
*Contributions are made tax-free!

Life Enrollment Form
Certificate - All Other Eligible
Certificate - FT Admin
Life Amendment 1
Life Amendment 2
Life Amendment 3