Wallace
Employee Benefit Programs
Documents, Forms, and Resources 2023
Kaiser Medical
2000 HMO Benefit Summary
HMO 1000 Benefit Summary
PPO 1000 Dual Choice Benefit Summary
HMO 2000 SBC
HMO 1000 SBC
PPO 1000 Dual Choice SBC
Enrollment-Change Form
Waiver Form
Convenient ways to get care
Pharmacy Resources
About Kaiser
Kaiser Dental
Traditional 2000 Benefit Summary
PPO 2000 Benefit Summary
Find Dentists and Locations
Choice PPO Provider Search
About Kaiser Dental
Standard Life Insurance and Disability
Basic Life and ADD Summary
Additional Life and ADD Flyer with Rates
Additional Life Insurance Medical History Statement
Life Insurance Summary Plan Description
Long Term Disability Summary Plan Description
Short Term Disability Summary Plan Description
Long Term Disability Summary
Short Term Disability Summary
Employee Assistance Plan Flyer
Enrollment Change and Beneficiary Form
File a Claim
About Standard
Standard Paid Leave Program
Paid Leave Model Notice
Flexible Spending Account and Dependent Care Account
How does a Healthcare FSA work
Enrolling in a Cafeteria Plan
Mobile App Flyer
Medical and Dependent Care Account Enrollment Form
Medical and Dependent Care Account Claim Form
Plan Information Report
Healthcare FAQ
Dependent Care FAQ
Contact PBS
Uprisehealth Employee Assistance Program (EAP)
Uprise Health EAP Flyer
Contact uprishealth
Notices
Exchange Model Notice
COBRA Model General Notice
Medicare creditable pharmacy disclosure
Wrap Plan Summary Plan Description
Cafeteria Plan Summary Plan Description
Cafeteria Plan Notice of Privacy Practices
Model Special Enrollment Notice
Patient Protection Primary Care Model Disclosure
Children's Health Insurance Program Notice (CHIP)
Notice Regarding Patient Protections Against Surprise Billing
Eligibility and Contributions
Employees must work 30 hours per week on a regularly scheduled basis
Coverage begins first of the month following 30 days of employment
Open enrollment is December 1 through December 31st for January 1, 2023 effective date
Employer pays 100% for employee only on the Kaiser base $2,000 deductible plan and Kaiser Traditional Dental plan
Employer pays 100% for Group Life Insurance, Accidental Death & Dismemberment, Short Term Disability and Long Term Disability
Voluntary Life Insurance and Accidental Death & Dismemberment Coverage is optional and requires premium contributions
Employees may enroll dependents in Health, Dental, and Life Insurance plans with premium contributions
Employee premium contributions for Health and Dental upgrades, or to add dependents, are pre-tax qualified contributions
2023 Benefits Price Rate Sheet
Contact Wallace Human Resources
Contact Paris Laughlin
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