HR/RM Menu

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HR-RM...Working together to promote a culture of excellence!

CBJ Benefits Open Enrollment
May 20th - June 7th, 2013

Health Insurance Forms & Information

Benefit Plan Rates Comparison-this provides the rates for each of the health insurance tiers
Premera Enrollment Form-use this form if you are making changes to your plan or adding/dropping a member
Affidavit of Marriage/Domestic Partnership-this form is required if you are adding a spouse/domestic partner to your health benefits
2013/2014 Benefit Plan Changes - information on changes to your health benefit plan.
HIPAA-health information privacy policy

Flexible Spending Account Forms & Information

Flexible Spending Account Info-not sure if you want to participate in the Flex Spending program...read this handout
Flexible Spending Account Enrollment Form-use this form to enroll in the Flexible Spending program

Benefits Information Email Contacts:

Health/Life Insurance Benefits

Privacy Notice - policies and practices to protect the confidentiality of plan participants' health information
COBRA Continuation of Benefits Notice
COBRA application
CBJ Benefit Booklet 2012-2013
24-Hour NurseLine
Employee Forms
- Enrollment/Change Form
- Medical, Dental, Vision Claim Form
- Prescription Claim Form:
  - Medco Mail Order Form - for Employee's Use
  - Medco Fax Order Form - for Health Care Professional's Use
  - Prescription Reimbursement Form
  - Secondary Insurance RX Claim Form
- CBJ Health/Life Insurance Benefits Advisor.
- Domestic Partner Termination Form
- Travel Benefit Advisory Form

Employee Wellness - Health Yourself

Contact Wellness Coordinator

Life Insurance Information

Health/Life Insurance Benefits Providers Websites

Merck-Medco.com
Premera.com
Lifewise.com - Lifewise Assurance Company

Other Employee Benefits

Employee Assistance Program - ComPsych® has been contracted by CBJ to provide support, resources and information to employees and their family on a confidential basis, at no charge to you, as a company-sponsored benefit.

Employees and family members are encouraged to visit the ComPsych® website at https:// www.guidanceresources.com/ groWeb/portals/login.portal or talk with a ComPsych representative by calling 1-800-295-9059 (TDD: 1-800-697-0353). To set up an online membership or to speak with a Guidance Consultant, you will need to provide the following company ID: CITYJEAP2.

Retirement Plans
- PERS website
- PERS Handbook
- PERS Defined Contribution Retirement (DCR) Plan (PERS Tier IV
Flexible Spending Account (FSA)
- FSA program details
- Authorization for Direct Deposit
- Health Care Reimbursement form

Dependent Care Claim form

More contents will be added to this site later. To request the addition of human resource or risk management forms or information, contact Anna Percival in the Human Resources & Risk Management Division at 586-5250 or Anna_Percival@ci.juneau.ak.us.