Embedded Files
Required Notices:
Required Notices:
Employer Sponsored Meeting Notice
Nursing Mother Employee Notice
Leave of Absence:
Leave of Absence:
Family and Medical Leave Act (FMLA)
Minnesota Paid Leave Employee Notice
Payroll Forms:
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.)
Health Savings Account - Payroll Deduction Authorization
403(b) Salary Reduction Agreement
Insurance Forms / Information:
Insurance Forms / Information:
Insurance forms are not available on the website because additional information is needed to determine action to be taken.
Coverage Summaries:
Coverage Summaries:
$15 Copay (Summary of Coverage)
$20 Copay (Summary of Coverage)
$1,700 / $3,400 Deductible (Summary of Coverage)
$4,000 / $8,000 Deductible (Summary of Coverage)
Cost Calculators:
Cost Calculators:
Insurance Cost Calculator - Teachers
Insurance Cost Calculator - Multi-Unit
Insurance Cost Calculator - Transportation
Insurance Cost Calculator - Community Ed
Health Savings Accounts/Flexible Spending Accounts:
Health Savings Accounts/Flexible Spending Accounts:
Health Savings Account - Payroll Deduction Form
HSA Account Set-Up (Magnifi)
403(b):
403(b):
403(b) Salary Reduction Agreement
Group Life Term:
Group Life Term:
Certificate of Insurance - Teachers
Certificate of Insurance - Support Staff
Certificate of Insurance - Transportation
Insurance - Life Beneficiary Change
Long Term Disability:
Long Term Disability:
Certificate of Insurance - Teachers
Page updated
Report abuse