CERTIFICATED

Welcome!  Please review all plan information and rates when making a selection.  Check out our Benefit Cost Calculator for assistance.


Highlighted below are the required forms to enroll.  Benefits are effective the first of the month following the date of hire.

All documents are DUE: 30-days from your date of hire

1. Medical Election Form

MEDICAL PLAN ELECTION FORM

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2. Medical Plan Enrollment Form 

(Kaiser and United Health Care Plans use the Universal Enrollment Form)
See below for plan descriptions
MEDICAL ENROLLMENT FORM

WAIVER FORM
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3. Dental Enrollment Form (if enrolling)
See below for plan descriptions

Delta Dental - ENROLLMENT FORM

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4. Vision Enrollment Form (if enrolling)
See below for plan description

MES ENROLLMENT FORM

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5. Minnesota Life Enrollment and Beneficiary Form (District-paid)
BENEFICIARY FORM
Minnesota Life Plan Summary and Rates
Minnesota Life Enrollment Form
Minnesota Life Evidence of Insurability Form 
(Evidence of Insurability is required if electing above the guaranteed issued amount)
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6. Disability Acknowledgement Form

Disability Acknowledgement Form

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IMPORTANT: If enrolling dependents, you must provide proof of dependent relationship. Please see dependent verification requirements: 
Dependent Verification Documents

Spouse: First page of the previous year Federal tax return showing the married filing status.

Child(ren): Birth Certificate naming employee or spouse as a parent.



Additional Information

Plan Comparison
Benefit Guide

2022 PLAN RATES

Medical Plan Descriptions

KAISER $20 PLAN

KAISER $30 PLAN
UHC NETWORK 1
UHC NETWORK 2
UHC NETWORK 3
UHC SIGNATURE VALUE HMO

Find out which medical group is covered in the UHC Networks 1, 2, and 3 by clicking here DIRECTORY or check online at UHC Provider Finder

OptumHealth Chiropractic

Kaiser Members: 800-428-6337

UHC Members: 800-624-8822

VEBA Advocacy Programs

Contact VEBA at: 888-276-0250

Best Doctors

Expert Medical Second Opinion; Ask the Expert; Find a Best Doctor; Critical Care Support

Contact at 866.904.0910 | members.bestdoctors.com

Dental Plan Descriptions

DELTA DENTAL PPO

DELTA DENTAL HMO

Please visit the Delta Dental website for provider directory, benefits, and claim forms:

Vision Plan Descriptions

MES VISION PLAN SUMMARY

Please visit the MES website for provider directory, benefits, and claim forms: mesvision.com