Benefit Information


Common Forms You May Need


Plan Type

Form Use(s)

Return To

403b Salary Reduction Agreement


Indicating per paycheck 403b contribution amount into 403b plan.

Jackie Gryczan – Employee Last Name A-L

Kenneth Woodard – Employee Last Name M-Z

Beneficiary Designation Form (Guardian)

Life Insurance

Indicate beneficiary(ies) on your life insurance policy.

Ross A. Breneman


Dental Change Form (HealthPartners)

Dental Insurance

Add/drop dependents or drop coverage entirely for dental insurance.

Dental Enrollment Form (HealthPartners)

Enroll in dental insurance.

Flexible Spending Election Form (Genesis/TASC)

Flexible Spending (FSA)

Elect Flexible Spending amounts for medical and daycare for 16-17 plan year.

Medical Enrollment / Change Form (PreferredOne)


Add/drop dependents for medical insurance

Enroll in medical insurance

Change from Low Deductible to High Deductible Plan

Change from High Deductible to Low Deductible Plan


If you have any questions, please contact Ross Breneman, in the Benefits Office.

Ross A. Breneman | District Benefits Coordinator



Open Enrollment

Open enrollment for 2015-2016 will be April 27th - May 8th, 2015. Click here for more information and video presentations


The district uses PreferredOne for our Medical coverage.

Pharmacy / Prescription Guide (pdf, 951 KB)

Create your account to compare prescription costs, locate pharmacies and more.


VEBA is a Health Reimbursement Account for employees on our PreferredOne Deductible health plan.


Vitality is our District wellness program, take charge of your health with Vitality!

Benefit Forms

Need an enrollment or change form? How about a claim form? They can be found here, along with others.

Retirement Health Benefits

Looking for health insurance information when you retire?

The 403(b) Scoop

The 403(b) is a tax-deferred retirement plan available for certain public school and non-profit organization employees.


Family Medical Leave Act protects your position if you need to take time off for a medical reason.


HealthPartners provides the district's dental care as of 7/1/16 forward.

Delta Dental is no longer the dental carrier as of 6/30/16.

Additional Benefits

403(b), Flex Spending, Life Insurance, LTD, Employee Assistance, PERA, Retirement, TRA, Wellness, and other benefits for working in the school district.