2021 Enrollment and Change
September 28 - October 30, 2020
2021 Enrollment and Change Kick-Off Meeting
2021 HRA Kick-Off Meeting Recording (Passcode: JDT*7^7T)
Slides of the benefits presentation PDF
Added-Value Tax Matrix
2021 Added-Value Tax Matrix PDF
2021 Deduction Schedules
2021 IowaBenefits Automatic Health and Dental P-1 Processing Schedule PDF
2021 Iowa Benefits Automatic Life P-1 Processing Schedule PDF
2020-2021 Health and Dental Deduction Schedule PDF
2021 Health and Dental Insurance Premiums
Employees |
Retirees |
| All Employees (except SPOC-covered) PDF | Non-Medicare Eligible PDF |
| SPOC-covered Employees PDF | Medicare Eligible PDF |
| COBRA PDF |
Verification/Documentation Forms
- Certification of Full-Time Student Status
- Declaration of Domestic Partnership
- Dependent Disability Certification
COBRA
- COBRA Notification/Election Form PDF
- 2021 COBRA Premiums PDF
- Health Insurance Application PDF
- Delta Dental Application WORD
Flexible Spending Accounts (FSA)
FSA Tips and Tools for HRAs
Employee Resources
2021 FSA Enrollment Brochure PDF
FSA Brochure for Terminating Employees PDF
HRA Resources
2021 Pay Period Calendar PDF (This calendar has the number of remaining pay periods per month. Helps when approving FSA enrollments and changes.)
Flexible Spending Accounts When Terminating an Employee in IowaBenefits PDF
How To Change FSA Bank Information in IowaBenefits PDF
HRA Tips for Flexible Spending Accounts PDF
FSA Forms
2021 Enrollment and Change FSA Enrollment Form PDF
2021 New Hires FSA Enrollment Form PDF
ASI Flexible Spending Plan Change in Benefit Election PDF
FSA Claim Form PDF
FSA Prepayment Form PDF
Life Insurance
2021 Premiums
All Employee except SPOC-covered PDF
SPOC-covered Employees PDF
Waiver of Life And Long Term Disability Insurance PDF
Pay Period Calendar
Premium Conversion (Pre-tax) Program
updated 10/14/2020