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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
Carry-Over
Over-The-Counter (OTC) Overview
Explanation Presentation
Plan Document / Summary Plan Description

 

Group Dental Insurance: Reliance Standard (using Ameritas Network)

Overview
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

Overview
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

Website
Summary of Benefits and Coverage 

 

Nebraska Public Employees Retirement System (NPERS)

Overview
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 
COBRA

 

Mileage Rates

2016
2017

 

Chief Deputy Benefits (excludes Chief Deputy Sheriff)

Chief Deputy Benefits

Let us help you with any of your questions regarding Sarpy County Human Resources.

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