Forms and Publications

Health Insurance

Employment

Flex

Information

Misc Info

e.g. Def Comp, YMCA Info, Svgs Bonds

• Adobe® Acrobat® Reader is free, and freely distributable, downloadable program that lets you view and print Adobe Portable Document Format-PDF files. 

HEALTH INSURANCE  - (PDF's)

• Benefits Coordinator's Newsletters

• Blue Cross Blue Shield of Illinois Website

  • Application & Policy Change .pdf

    • Directions .pd

  BCBS for Questions & Information
  Prescription Drugs, Other Services - Vision, Mental Health, Breast Cancer Screenings, Well-Child Care, Dental, etc.

  Medical Highlight Sheet .pdf (updated and effective 01/01/2008)

  Claim Form (Medical) .pdf

  Co-Pay .pdf

  Dental Highlight Sheet .pdf

  Dental Claim Form .pdf

  BCBS Vision Discount Program

  Davis Vision .pdf September 14, 2009

• Contact Lens .pdf
• Discount Vision Program Providers
• Laser Vision Correction .pdf

Employee Health Care Benefits Booklet .pdf

2010 Health Insurance Rates .pdf December 3, 2009

Insurance Buy Out Program-2010 .pdf 11/ 2009

PPO Benefit Changes

Student Dependent Certificate .pdf

2010 Changes in Age Limits for Dependents .pdf Decmeber 11, 2009

Over Aged Dependents 2010

Prescription Drug Program Highlight Sheet .pdf

Prescription Drug Card Claim Form .pdf September 14, 2009

• Introductory Letter '04 for PrimeMail, Prim Therapeutices' mail service.pdf
  • Home Delivery Prescription Drug Program Benefit Brochure .pdf
  • PrimeMail Pharmacy - Home Delivery Order Form  .pdf
  • PrimeMail Pharmacy - Physicians' Direct Fax .pdf
  • PrimeMail's Website

COBRA -Continuation of Health Insurance  .pdf

• DEFERRED COMPENSATION

  • ICMA 

    • Contribution Limits

  • NACO/PEPSCO Nationwide

    •  Contribution Limits

• IMRF - ILLINOIS MUNICIPAL RETIREMENT FUND
• Telephone:  800-ASK-IMRF (800-275-4673)
  • IMRF service credit information .pdf
  • IMRF - Voluntary Additional Contribution Information
  • IMRF - Voluntary Additional Contribution Enrollment Form - County
  • IMRF - Voluntary Additional Contribution Enrollment Form - Forest Preserve

  - IMRF Numbers
       County #2996
       Forest Preserve #  0944

EMPLOYEE ASSISTANCE PROGRAM

• The Employee Assistance Program counselors are available 24 hours a day, seven days a week:
  Daytime and evening appointments are available: 
  Monday – Thursday: 8:00am – 8:00pm
  Friday: 8:00am – 4:00pm   
  For confidential, professional assistance:  (815) 748-8999 *
  
  In the event of a crisis after hours:     
                     (800) 373-3327 *  
  * The counselors will be paged immediately in the event of a crisis.
  * KishHealth System also offers Outpatient Counseling.

FEDERAL TAX ID NUMBERS
    County #36-6006548
    Forest Preserve # 36-6009176
    PBC #  36-3026498

Kishwaukee United Way Pledge Card (pdf)

LIFE INSURANCE PLAN .pdf

SAVINGS BOND INFORMATION

• Savings Bonds I .pdf
• Saving Bonds EE .pdf
• Series EE Savings Bonds to earn fixed rates beginning with May 2005 issues (5/4/2005) .pdf

VOLUNTARY LIFE INSURANCE

• NCPERS Plan Benefits - Voluntary Life Insurance Plans $16/$12/$9 (effective 6/01/2002) .pdf
• Enrollment Letter .pdf  --October 16, 2009 
• Voluntary Life Insurance purchase instructions (effective 11/08) .pdf

YMCA FORMS

DeKalb Optometric
$5.00 Off Eye Exam
 20% Off Glasses, Lenses, Frames, & Extras
10% off disposable contact lens

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