Riverview School District

BENEFITS

Carrier website:

PREMERA BLUE CROSS

• PPO 2
• PPO 3
• Easy Choice A, B, and C
• QHDHP (Qualified High Deductible Heath Plan)
• PPO 5

GROUP HEALTH

NBN VISION

• NBN Vision Claim Form

WASHINGTON DENTAL SERVICES

UPoint

Summaries of Benefits and Coverage (SBCs)

AMERICAN FIDELITY

• Flexible Spending Plan
• Disability Insurance

CIGNA

• Long Term Disability Insurance
• Life Insurance

WA State Department of Retirement (DRS)

Deferred Compensation Program

Guaranteed Education Tuition Program (GET)

403b Universal Availability Notice

Health Care Authority (PEBB)

VEBA

OTHER PAYROLL FORMS and INFORMATION

• IRS Form W-4
• "Thinking about Retirement"
• Notice of Retirement / Resignation Form
• School Employee Credit Union of Washington
• Direct Deposit Enrollment or Change
• Personnel Data Change Form
• Just Married Checklist
• Staff Development Form for Classified Staff

Prescription Reimbursement (PREMERA)
Find a Doctor

Request enrollment form from payroll & benefits office (GROUP HEALTH)

• LTD Claim Form (ask Payroll)
• Beneficiary Form

Beneficiary Change Form