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Benefit Forms & Information
Medical / Prescription Drug, Dental & Vision
- Wayne County Notice of Creditable Coverage for 2024
- Side-by-Side Benefit Comparisons for medical, dental, vision and hearing information specific tovarious collective bargaining agreements / benefit plans / retirees
- Plan Summaries and Benefits-at-a-Glance for each plan
- BCBSM Right Care information on lower-cost alternatives for Emergency Care
- BCBSM Preventive Care Saves Lives
- BCBSM / BCN Custom Select Formulary Quick Guide
- DENCAP Retiree FAQ
- DENCAP Retiree Advantage Schedule
Flexible Spending Accounts (FSA), Health Savings Accounts (HSA) & Retiree Medical Savings Accounts (RMSA)
- Plan Documents & Account Access
- FSA - American Fidelity
- HSA - Health Equity
- RMSA - MERS of Michigan (also known as Health Care Savings Plan or Employee Health Trust Plan)
- Frequently Asked Questions (FAQs)
- HSA Guide
- Qualified Medical Expenses
- Tax Benefit Example
- HSA Annual Tax Saving Potential Flyer
- HSA Member Brochure
- WEBINARS:
- HSA Basics- Harness the Power of an HSA- Webinar Register
- HSA Your Way: Spend, Save, and Invest in Your Healthcare Presentation
- MERS-Health Care Savings Program-Webinar
- MERS-Health Care Savings Program-Webinar
- FSA Enrollment Forms:
Employee Assistance Program (EAP)
- Employee Assistance Program (EAP) - FREE & CONFIDENTIAL counseling services available 24/7/365 to employees and family members through HMSA
- Employee Benefit Summary 5FTF Wayne County
- EAP Recorded Message
Life Insurance
- Basic Group Life Insurance: Basic (employer-paid) life benefits are determined by the terms and provisions of applicable collective bargaining agreements and benefit plans.
- Supplemental Group Life Information
- Beneficiary Designation Information
- Notice of Conversion and/or Portability Rights Form
Other Value-Added Benefits & Voluntary / Supplemental Benefits
- Value-Added Benefits for Active Employees
- Virtual Well-Being Webinars
- More info on BCBSM website: Webinar Information
- LIVONGO by Teladoc Health Diabetes
- Voluntary Benefit Plan Options:
- TMR & Associates
- American Fidelity
Benefit Forms
- IRS 4506T Form (use for dependent and/or income verification)
- Medicare Advantage Enrollment Form (EXEC/LEGISLATIVE)
- Medicare Advantage Enrollment Form (LEGISLATIVE)
- Medicare Advantage Enrollment Form (ALL OTHER) --Information: 2021_ Wayne_County_Medicare_Advantage_PPO_BCN
- Health Equity Refund Form
- HSA Annual Wage Bonus Contribution
- HSA One-Time Payroll Deposit Authorization
- HSA Regular / On-Going Contribution Form
- HSA PRORATED Bonus Form
- The Hartford Charter of Wayne Benefits Enrollment / Supplemental Group Life Insurance Form
- The Hartford Beneficiary Designation Form
- Notice of Conversion and/or Portability Rights Form
- Enrollment Change of Status Form
- Optical Reimbursement Form
- Flexible Spending Account Election Form
- Healthcare Opt Out
Frequently-Used Links
- American Fidelity
- Blue Cross Blue Shield of Michigan (BCBSM)/ Blue Care Network (BCN)
- Dencap Dental Plan (retirees only)
- Delta Dental Plans
- Golden Dental Plans
- Hartford Life
- Health Equity
- Health Management Systems of America (HMSA)
- Heritage Vision Plans
- Municipal Employees Retirement System (MERS)
- Wayne County Employee Retirement System
