FPS

• I-9
• Federal W-4
• Nebraska W-4
• Direct Deposit Form

Required Forms

• *Blue Cross Blue Shield Enrollment Form
• *Election/Declination Form
• *Met Life Enrollment Form – This $10k Life Insurance Policy and Long Term Disability is provided to all Certified employees at no cost to the employee.
• *Voluntary Life Insurance Enrollment Form – You are eligible for up to 5x your annual income, up to 100k, in voluntary life insurance coverage without having to provide evidence of insurability. If you decline during your initial enrollment period (when you’re hired), there is open enrollment every fall. However, the maximum employees are allowed to sign up for is 20k during open enrollment. So it will take five years to build your coverage up to what you are eligible for during your initial enrollment period.
• *NPERS Beneficiary Form – This form requires a Notary for your signature. Kate Baker, the HR Coordinator, is a notary! Be sure to make an appointment when dropping off your paperwork and we can get your form notarized for you. Please don’t sign it prior to arriving for your appointment.

Optional Forms

• New Teacher One-Time Salary Advancement Form
• Vision Enrollment Form
• Vesting Credit for Retirement (NPERS) – If you have been enrolled in another Nebraska state retirement plan, complete this form and follow the instructions regarding submitting it to the NPERS office.
• FPS Foundation Donation Form
• YMCA Enrollment Form (return to Kristyn Drey, our Payroll Associate) – FPS offers payroll deduction for YMCA members. FPS employees also have their joiner fee waived by the YMCA. To join, complete the form at this link and return it to the Payroll office. We will share it with the YMCA. You will still need to go to the YMCA for a membership card and facility information.

The information below is for the 23/24 school year. If the link is not active, the information is not yet available. It will be updated as soon as the information is made available.

• Health and Dental Insurance/Blue Cross Blue Shield (BCBS) Certified Rates 2023/24
• Plan / Network / Costs Breakdown
• Health Insurance Alternative Network FAQs
• Health Insurance/BCBS Benefit Summary for PPO Health Coverage  – $1200/$0 Deductible
• Health Insurance/BCBS Benefit Summary for HSA-Eligible $3800 (Network Blue) Plan
• Health Insurance/BCBS Benefit Summary for HSA-Eligible Plan $2500 (Alt. Network) Plan
• BCBS Dental Plan Summary – Option 2
• BCBS Dental Plan Summary – Option 3
• Dental Coverage Breakdown (A, B, C)
• Voluntary Life Insurance Summary of Benefits
• Vision Plan Summary
• NPERS (Retirement) – New Member Information Packet
• NPERS Member Handbook
• Traveler’s Identity Fraud Information
• AFLAC (Short-Term Disability, Accident Insurance, Hospitalization, Group Cancer Insurance)
• Colonial Life Group Cancer Insurance – To Enroll or for more information, contact Criss Butler at Criss.Butler@ColonialLifeSales.com or 402-333-5208 Ext. 2
• ASI Flexible Spending Accounts (Health and Dependent Care Offered) – Flex Account enrollment is online during the month of August. Instructions for enrollment will be sent, along with the information found here, during open enrollment.