Payroll and Benefits

Required Notices

Employer Sponsored Meeting Notice

ESST Becker Notice 23-24

Nursing Mother Employee Notice


Leave of Absence

Family and Medical Leave Act (FMLA)

Request for Leave of Absence


Payroll Forms

Federal Tax Withholding - Federal Form W4      (Must also submit new MN W4 even if no changes are being made.)

State Withholding - State Form W4             (Must also submit new Federal W4 even if no changes are being made.)

Payroll Direct Deposit

Health Savings Account - Payroll Deduction Authorization

403(b) Salary Reduction Agreement

Extra Pay Time Sheet


Insurance Forms / Information 

Insurance forms are not available on the website because additional information is needed to determine action to be taken. 

Coverage Summaries:

$15 Copay (Summary of Coverage)

$20 Copay (Summary of Coverage)

$1600 Deductible (Summary of Coverage)

$4000 Deductible (Summary of Coverage)

Benefit Guide - Health Partners

HealthPartners Tips and Resources

Coverage Overview & Member Handbook

Mail Order Pharmacy

Employee Assistance Program

Dental Plan Overview 

Dental Summary (Policybook)


Cost Calculators:

Insurance Cost Calculator - Teachers

Insurance Cost Calculator - Local 284 Multi Unit

Insurance Cost Calculator - Transportation

Insurance Cost Calculator - Community Ed.


Health Savings Accounts/Flexible Spending Accounts:

Health Savings Account - Payroll Deduction Form

HSA Eligibility Checklist

HSA Account Set-Up (Magnifi)


403(b):                       

403(b) Salary Reduction Agreement

403(b) Vendor List

Universal Availability Notice


Group Life Term

Certificate of Insurance - Teachers

Certificate of Insurance - Support Staff

Certificate of Insurance - Transportation

Insurance - Life Beneficiary Change


Long Term Disability

Certificate of Insurance - Teachers

Certificate of Insurance - Support Staff

Certificate of Insurance - Transportation