Benefit Guide and Summary Plan Description
Benefits Guide for contract employees for the 2012/2013 plan year
Mesa Public Schools Benefits Plan Document/Summary Plan Description
Flex Benefits Program Summary Plan Description
Mesa Unified School District #4 403(b) Plan Document
TDA Dental HMO Coverage and Copayments
Cigna Dental PPO Coverage Summary
General Benefit Documents
Learn More About Flexible Spending Accounts
IRS Health Care Eligible Expenses
Over the Counter Drug List
Long Term Disability Income Plan
Medicare Part D Notice of Creditable Coverage
Short-term disability Summary of Benefits
Rate Sheets
For Medical, Dental and Vision rates, please login to BenefitFocus using the following link mpsaz.hrintouch.com
2012-2013 Optional Life Rates
2012-2013 Short Term Disability Rates
Forms
403(b)/Hartford Forms
- Contribution Change Form
- Beneficiary Designation Form
- Loan Application Form (also require Loan Payment Form)
- Loan Payment Form (required with Loan Application Form)
- In-Service Withdrawal Request Form
ASRS Beneficiary Form
ASRS Address/Name Change Form
Cigna Dental PPO Claim Form
Dependent Care Flexible Spending Account Claim Form
Health Care Flexible Spending Account Claim Form
HIPAA Privacy PHI Authorization Form
HSA Change Form
Long Term Disability Application
Short Term Disability Claim Form
Sun Life Evidence of Insurability Form (online submission - enter group # 213993)
Sun Life Evidence of Insurability Form (paper form)
United Pet Care Member Change Form