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PSUSD
Benefits
Classified Employees
CLASSIFIED - ACTIVE
2021-2022 TEAMS I RATES
2021-2022 TEAMS I RATES.pdf
279.19 KB
(Last Modified on September 28, 2021)
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2021-2022 TEAMS II RATES
2021-2022 TEAMS II RATES.pdf
278.96 KB
(Last Modified on September 28, 2021)
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2020-2021 TEAMSTER BENEFIT GUIDE
01 PSUSD BG TEAMSTERS ACTIVE 2020-2021 10.01.20.pdf
6.44 MB
(Last Modified on September 18, 2020)
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TEAMSTER/CLASSIFIED FORMS
TEAMSTERS ENROLLMENT/CHANGE FORM
Teams Enrollment Form 4.04.17.pdf
445.02 KB
(Last Modified on August 25, 2017)
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TEAMSTERS LIFE INSURANCE BENEFICIARY DESIGNATION FORM
Teams Life Insurance Beneficiary Designation Form.pdf
82.94 KB
(Last Modified on August 25, 2017)
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TEAMSTERS CHANGE OF ADDRESS FORM (SEND TO NWA)
NWA Change of Address Form.pdf
42.76 KB
(Last Modified on August 25, 2017)
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DENTAL
DELTA DENTAL PPO INCENTIVE PLAN SUMMARY
Delta Dental PPO Incentive Plan Summary 2017.pdf
536.76 KB
(Last Modified on February 21, 2018)
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DELTA DENTAL PPO PLAN SUMMARY
Delta Dental PPO Plan Summary 2017.pdf
531.58 KB
(Last Modified on February 21, 2018)
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DELTACARE USA HMO PLAN SUMMARY
DeltaCareUSA HMO Plan Summary 2017.PDF
372.31 KB
(Last Modified on February 21, 2018)
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DELTA DENTAL ENROLLMENT/CHANGE FORM
Delta Dental Enrollment Form Active.pdf
212.24 KB
(Last Modified on August 25, 2017)
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LIFE
LEGAL
METLAW - ENROLLMENT FORM
MetLaw Enrollment Form 8.15.17.pdf
148.09 KB
(Last Modified on August 25, 2017)
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COBRA
COBRA RATES 2020 - 2021
COBRA Rates Oct. 2021- Sept 2022.pdf
100.64 KB
(Last Modified on September 7, 2021)
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COBRA RATES 2021 - 2022
COBRA Rates Oct. 2021- Sept 2022.pdf
100.64 KB
(Last Modified on September 7, 2021)
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COBRA VISION ENROLLMENT FORM
Vision Enrollment Form - COBRA.pdf
44.85 KB
(Last Modified on October 17, 2017)
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COBRA DENTAL ENROLLMENT FORM
Delta Dental Enrollment Form COBRA.pdf
180.83 KB
(Last Modified on October 17, 2017)
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