Information and forms may also be obtained from the Human Resources Department. If you are seeking additional information that is not found here, please contact the Human Resources Department at 248.364.6803. You may also send us an e-mail.
Employee Assistance Services
Contact Information: 800.969.6162
Medical Insurance Coverage
Administrator: Alliance Health and Life Insurance (HAP)
Contact Information: 888.999.4347
Summary of Benefits & Coverage (SBC) Information for 2019
EPO - Groups 1800,1801,2001
PPO - Groups 1700, 1701, 1901
EPO - Group 1401
Prescription Drug Coverage
Administrator: Employee Health Insurance Management
Contact Information: 800.311.3446
Summary of Benefits & Coverage (SBC) Information for 2018
POLC - Command
POLC - Detectives
POLC - PO
POLC - PO Retirees $5.00
POLC - PO Retirees $7/$15/$30
Administrator: Delta Dental
Contact Information: 800.482.8915
Administrator: EyeMed Vision Care
Contact Information: 866.800.5457
EyeMed Vision Care Approved Doctor List
Summary of Benefits
Out of Network Vision Services Claim Form
EyeMed Vision Care
Attn: OON Processing
PO Box 8504
Mason, OH 45040
- Status Change Form
This is the form you use to change information about yourself or dependents for benefit coverage (births, marriages, divorce, etc.). You can also use this form to update your address, phone number or to update your emergency contacts. Return completed form to HR.
- 401K Contribution Change Form
Use this form to make changes to the amount of your ICMA-RC 401k plan contribution.
- 457 Deferral Change Form
Use this form to make changes in the amount of your deferral to your ICMA-RC 457 Deferred Compensation Plan.
- Direct Deposit Form
This is the form that you use to enroll, change, or drop Direct Deposit of payroll checks. Return completed form to payroll.
- Educational Assistance Form
This is the form you use to get reimbursed for tuition expenses. The top of the form must be filled out and signed by your supervisor. Once that is done, send the form to HR for approval. Once a decision has been made the form will be sent back to you. After completing the class return the form with your receipts and grade (a C or above must be earned in order to get reimbursed). Return to Supervisor prior to beginning coursework.
- Request to Retire Form
This is the form that you use in preparation for your anticipated retirement. Return completed form to HR.
Click to change your Tax information: