Insurance Documents

Sarpy County

(Insurance benefits are generally available to employees classified as working 30+ hours per week or deemed eligible persuant to the Affordable Care Act)

OPEN ENROLLMENT for Calendar Year 2020: November 4 - November 15, 2019

  Tutorial: ADP Employee Self-Service for OPEN ENROLLMENTS

 

Group Health Insurance:  Blue Cross/Blue Shield - Information below for covered employees

Member Services: 1-888-592-8961

2019 Blue Cross/Blue Shield Premiums

2020 Blue Cross/Blue Shield Premiums

Retirement Programs (2019)

Retirement Programs (2020)

Schedule of Benefits Summary (05-01-2019)

Schedule of Benefits Summary (01-01-2020)

Summary of Benefits and Coverage (2019)

Summary of Benefits and Coverage (2020)

Certificate of Coverage (2019) 

Certificate of Coverage (2020) 

Plan Comparison CY 2020

Group Health Insurance: General Information and Documents Below

Telehealth
Network Quick Guide.pdf
Tutorial: How to find an In-Network Provider
MY BLUE:Website for creating a subscriber account
Pre-Authorization List (link to website) 

GoodRx - link for Tracking/Comparing Drug/Prescription Costs!

Naco Benefit: Term Life Insurance

Certificate of Coverage (must be enrolled in SARPY County BCBS Health Insurance)

  In-Network Partial-Self Fund: Employee Benefits Systems (EBS) 

  Claims Processing Illustration  (CY 2019)

   Claims Processing Illustration  (CY 2020)
 
   Summary of Benefits and Coverage  (CY 2019)

      Summary of Benefits and Coverage (CY 2020) 

   Summary Plan Document

        EBS: Link to Website

     
Flexible Spending Accounts: General Information and Documents Below

2019 Payflex1-844-729-3539

Welcome to Payflex

Connected Claims Solutions

Keep Your Card Active

PayFlex Healthcare or Dependent Care Claim Form

PayFlex Release Form

PayFlex FSA Election Change Form

PayFlex Direct Deposit Form

Sarpy County PayFlex Reimbursement Plan

Sarpy County PayFlex Acknowledgement Resolution

Sarpy County PayFlex - Reimbursement Plan / Cafeteria Plan

 Sarpy County PayFlex Summary Plan Document     
 

~~~ANCILLARY INSURANCES~~~

**METLIFE CUSTOMER SERVICE** 

         800-GET-MET8  

MetLife Premium Rates CY 2020  
MetLife Privacy Notice

Group Dental Insurance:  MetLife effective 1/1/19

MetLife Summary of Benefits effective 1/1/18 (for covered employees and dependents)

Certificate of Coverage  (for covered employees and dependents)

Tutorial For Finding A Dental Provider

      https://mybenefits.metlife.com/MyBenefits/public/ssi/commonAccess.do

Employee Dental Infomation (for covered employees and dependents)

Dental Summary* for Sarpy County Dental Insurance (for covered employees and dependents)
       *Summary ONLY  - please review the Certificate of Coverage/contact MetLife for further details

Vision Discount Card (for covered employees and dependents)
 

Group Term Life Insurance: MetLife effective 1/1/19

Certificate of Coverage: $30,000 (for covered employees)
Life Insurance SUMMARY*: $30,000 (for covered employees)
     *
Summary ONLY  - please review the Certificate of Coverage/contact MetLife for further details

Certificate of Coverage: $45,000 (for covered employees)
Life Insurance SUMMARY*: $45,000 (for covered employees)
     *
Summary ONLY  - please review the Certificate of Coverage/contact MetLife for further details

Beneficiary Form

~ADDITIONAL BENEFITS IF COVERED UNDER GROUP TERM LIFE INSURANCE~
Grief Counseling / Funeral Assistance
Dignity Funeral Planning
Will Center

Voluntary Supplemental Term Life Insurance 

Cost sheet for Voluntary Supplemental Life Insurance
Certificate of Coverage: Voluntary Supplemental (for covered employees and covered dependents)
Voluntary Supplemental Life Insurance SUMMARY*
     *
Summary ONLY  - please review the Certificate of Coverage/contact MetLife for further details

Beneficiary Form 

~ADDITIONAL BENEFITS IF COVERED UNDER VOLUNTARY SUPPLEMENTAL INSURANCE~
Estate Resolution Services
Will Preparation

 

Group Long-Term Disability Insurance: MetLife effective 1/1/19

Certificate of Coverage: Less than $30,000 annual pay (for covered employees)
Certificate of Coverage: $30,000 or more annual pay (for covered employees)

 

Voluntary Vision Insurance Coverage - MetLife Vision PPO: MetLife effective 1/1/20

Voluntary Vision Benefit Summary 
Voluntary Vision Summary and Cost Sheet
Voluntary Vision Summary & Cost Sheet v.2     
     LINK to finding an In-Network Provider 
        ~select "Find a Vision Provider"
        ~select "MetLife Vision PPO"
        ~enter Zip Code

CHI Health Employee Assistance Program (EAP): 402-398-5566

Website

Summary of Benefits and Coverage 2019

Summary of Benefits and Coverage 2020

Nebraska Public Employees Retirement System (NPERS): 1-800-245-5712

Overview
Access to Full Website
Forms Link
County Handbook Link
Publications / Newsletter Link

Supplemental/Volunteer Benefits

457(B) DEFERRED COMPENSATION / 401(A) MATCH VOLUNTARY PROGRAM

Resolution 2019-045: Adoption of Plan Agreement 

 PROVISIONS: Collective Bargaining Agreements ~ Personnel Policy Bulletin

FAQs  

457(b) Deferred Compensation / 401(a) Match Voluntary Program – FORM

457(b) Deferred Compensation / 401(a) Match Voluntary Program – FORM for F.O.P. Sworn

Lincoln Retirement Services Documents (Resolution 2019-355)

Nationwide & Morningstar Fiduciary Service Agreement (Resolution 2019-356)

Voya Retirement: Contract Holder Direction and Acknowledgement (Resolution 2019-354) Effective 01/15/2020

The below are ancillary voluntary benefits and providers.  There is no endorsement made by Sarpy County for one company versus another.
       
As the benefits are voluntary, employees are to contact the representative directly for information.  
       
Vendor Contact Person Contact information Types of Products
AFLAC Mark Friehe cell:  402-690-0594 mark_friehe@us.aflac.com Accident, Cancer, Criticall Illness, Supplemental Insurance, Etc.
Colonial Emmalee Westfall cell:  402-452-7614   Emmalee.westfall@coloniallife.com Accident, Cancer, Criticall Illness, Supplemental Insurance, Etc.
Fort Dearborn Life   800-538-0379 Life Insurance
VOYA Financial (ING) Marshall Egermier cell:  402-445-2121  marshall.egermier@voyafa.com Deferred Compensation
Nationwide Matt Ring cell:  515-218-0303  ringm3@nationwide.com  Deferred Compensation
SilverLeaf Wealth Management (Mass Mutual) Peter Daiker Phone 402-934-7200  Fax 402-260-7073 Deferred Compensation, 529 Educational Savings Plan
Lincoln Financial Peter Daiker Phone 402-934-7200  Fax 402-260-7073 Deferred Compensation
Legal Shield Patrick Lillis cell:  210-627-1423  plillis@legalshieldassociate.com  Pre-paid Legal Services and Identity Theft protection

Legal Documents/Notices

Notice of HIPAA Privacy Practices
      Contact HR to request a paper copy

Glossary of Health Coverage and Medical Terms
      Contact HR to request a paper copy

CHIP (Children's Health Insurance Program) Notice
       Contact HR to request a paper copy

Continuation Coverage Rights Under COBRA
      
Contact HR to request a paper copy

Health Insurance Marketplace Coverage Options and Your Health Coverage

Women's Health and Cancer Rights Act

Mileage Rates

2019 Mileage Reimbursement Rates (Revised 1-2-19)

Exempt Management Benefit Summary

Fringe Benefit Summary: Exempt Management  (effective 11-05-2019)

Chief Deputy Benefits (excludes Chief Deputy Sheriff)

Chief Deputy Benefits