HUMAN RESOURCES

Employee Online

View Paystubs Online

Employee Online Instructions

Employee Online W-2 Instructions

Please contact the Payroll Department with issues regarding your password and questions.


Employee Forms

Name and Address Change Form

Direct Deposit Form

City Tax Form

State Tax Form

Federal Tax Form


Deferred Compensation (409A) Pay Option Election Form

Administrator Forms

Report of Vacancy Form

Additional Pay Timesheet

School Forms

Application for Volunteer/Contracted Services

Bloodborne Pathogen Training

Bloodborne Pathogen Training

District PSD History Link

http://intranet.phasd.us/psdhistory/



BENEFITS INFORMATION


MESSA Insurance

The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment

ACA Mandated Summary of Benefits and Coverage for Teachers, Secretaries and Paraprofessionals

2016/17 Insurance Cost for Teachers

2016/17 Insurance Cost for Secretaries with HSA

2016/17 Insurance Cost for Secretaries without HSA

2016/17 Insurance Cost for Paraprofessionals with HSA
2016/17 Insurance Cost for Paraprofessionals without HSA


MESSA ABC Plan 1 Application

MESSA Member Change Form
MESSA Beneficiary Designation Form

Life & Accident Insurance Certificate Booklet for Teachers, Counselors and Psychologists with Health Insurance
Life & Accident Insurance Certificate Booklet for Teachers, Counselors and Psychologists without Health Insurance

Long Term Disability Summary of Plan Benefits

Life Insurance Summary of Plan Benefits (Optional Insurance)
Long Term Disability Summary of Plan Benefits (Optional Insurance)
Short Term Disability Summary of Plan Benefits (Optional Insurance)

MESSA Optional Insurance Rates

Who Can Be An Eligible Dependent?
How To Create a MESSA Member Log-In and Password
How To View Your MESSA Benefits
List of Free Prescriptions

DELTA Dental Summary of 
Plan Benefits
DELTA Dental 80% Non-Coordination of Benefits Highlights
DELTA Dental 50% Coordination of Benefits Highlights

VSP Vision Summary of Plan Benefits
VSP Vision Plan Highlights

Waiver of Health Insurance - For Secretaries and Paraprofessionals
Waiver of District Contribution to Health Savings - For Secretaries and Paraprofessionals

Health Equity

Healthy Equity Website

Health Savings Account Reimbursement Form

Health Savings Account Advancement Request Form

2017 H.S.A. Payroll Deduction Authorization Form

Health Savings Account and Flexible Spending Account Information

IRS Publication 502 - Qualified Medical and Dental Expenses

IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans

Priority Health Insurance


The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment. You can view this by clicking on the link below that pertains to your bargaining unit:

ACA Mandated Summary of Benefits and Coverage

Priority Health Insurance Cost 2016/17

High Deductible Plan 90% Summary of Plan Benefits
High Deductible Plan 100% Summary of Plan Benefits

Application for Plan 1 A
Application for Plan 1 B

Application for Plan 2 A
Application for Plan 2 B
Application for Plan 2 C

Priority Health Member Change Form

Waiver of District Contribution to Health Savings Account

Chemical Bank

2017 H.S.A. Payroll Deduction Authorization Form

Health Savings Accounts for Priority Health Members are established through Chemical Bank. An account can be opened at any Chemical Bank location.

CIGNA Dental Insurance


CIGNA Dental Enrollment/Change Form

Building Administrators/Central Office/Confidential's/Hourly Service Personnel, Coordination of Benefits, Dental Summary of Plan Benefits

Building Administrators/Central Office/Confidential's/Hourly Service Personnel, Non-Coordination of Benefits, Dental Summary of Plan Benefits

Teamsters Dental Summary of Plan Benefits

Food Service Dental Summary of Plan Benefits

Paraprofessional Dental Summary of Plan Benefits

Secretary with Health Summary of Plan Benefits

Secretary without Health Summary of Plan Benefits


CIGNA Life Insurance

CIGNA Beneficiary Designation Form

Mutual of Omaha

Building Administrators LTD Summary of Benefits

Building Administrators Life Insurance Policy

Central Office/Confidentials/Service Personnel LTD Summary of Benefits

Central Office/Confidentials/Service Personnel Life Insurance Policy

Custodians LTD Summary of Benefits


Custodians Life Insurance Policy

Food Service Life Insurance Policy

Secretary LTD Summary of Benefits (20+ Hours)

Secretary LTD Summary of Benefits (10 - 19 Hours)

Secretary STD Summary of Benefits (20+ Hours)

Secretary STD Summary of Benefits (10 - 19 Hours)

Hourly Service Personnel Life Insurance Policy
 

SET SEG

Paraprofessional/Secretary Life Insurance Policy


EyeMed Vision Insurance

EyeMed Enrollment/Change Form


Family Medical Leave Act

Employee Rights under FMLA

FMLA Questions and Answers

Federal Mandates

403(B) & 457 Information

403 (b) Plan by MidAmerica

Notice of Universal Availability Eligibility to Contribute to 403 (b) / 457 Plans

403(b) Plan Highlights

403(b) Salary Reduction Agreement

457 Plan Highlights

457 Salary Reduction Agreement

457 Plan Deferred Compensation Option through ORS

Office of Retirement Services (ORS)

Office of Retirement Services Website  

ORS Beneficiary Election Form

ORS Name and Address Change Form