Insurance Documents

Sarpy County

In-Network Partial-Self Funding: Employee Benefits Systems (EBS) (1/1/17-12/31/17)

Claims Processing Illustration
Summary of Benefits and Coverage
Summary Plan Document


Flexible Spending Accounts: General Information and Documents Below

ASIFlex (link to website)
Mobile Access
Claim Form
Over-The-Counter (OTC) Overview
Explanation Presentation
Plan Document / Summary Plan Description


Group Dental Insurance: Reliance Standard (using Ameritas Network)

Highlights of Coverage
Certificate of Coverage
Provider Lookup Link (Plan Type: Classic PPO)
Vision Discount Program - available if enrolled in Dental Insurance


Group Term Life Insurance/Voluntary Supplemental Life Insurance: Reliance Standard

Certificate of Coverage: $30,000
Certificate of Coverage: $45,000
Cost sheet for Voluntary Supplemental Life Insurance
Certificate of Coverage: Voluntary Supplemental
Beneficiary Form 


Group Long-Term Disability Insurance: Reliance Standard

Certificate of Coverage: Less than $30,000 annual pay
Certificate of Coverage: $30,000 or more annual pay


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

Summary of Benefits and Coverage 


Nebraska Public Employees Retirement System (NPERS)

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


Supplemental/Volunteer Benefit Providers

Link to contact list


Legal Documents/Notices

Notice of HIPAA Privacy Practices
Glossary of Health Coverage and Medical Terms
CHIP (Children's Health Insurance Program) Notice
Reliance Standard: Privacy Statement 


Mileage Rates



Chief Deputy Benefits (excludes Chief Deputy Sheriff)

Chief Deputy Benefits

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