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Employees
Employee Forms
Tax Forms
- 2023 W-4 Form (Federal Income Tax Withholding)
- WH-4 Form (R8 09-202) (State and County Tax Withholding)
Insurance Forms
Retirement Forms
Compensation Forms
- Paycheck Direct Deposit Form
Personnel Forms
Workers Compensation Forms
Employee Benefits
For assistance with providers, claims, benefits, cost containment solutions, appeals, and denials please contact NavCare Concierge Services at 877-208-5952 or carenavigators@valenzhealth.com. When outside your primary network call 800-226-5116 or go to myfirsthealth.com to locate a provider.
For prescriptions, call TrueScripts at 1-844-257-1955. www.truescripts.com
Employee Clinic (Hancock HealthWorks) and Gateway Information
- Hancock HealthWorks Appointment Scheduler
- Hancock HealthWorks Scheduling Instructions
- Hancock HealthWorks Locations and Hours
- Hancock HealthWorks Services
- Hancock HealthWorks Drug and Lab List
- Hancock Health Gateway Information
2023 Medical, Dental & Vision
- Plan 1 (PBA PPO, Co-Pay) Summary of Benefits
- Plan 2 (PBA PPO HSA) Summary of Benefits
- 2023 Summary of Rates per Pay
- 2023 Health Savings Account (HSA) Fact Sheet
- Dental Summary of Benefits
- Vision Summary of Benefits
Family Medical Leave Act (FMLA) Administered by FMLASource
AFLAC (Voluntary Coverage)
Short Term/Long Term Disability
- Disability Coverage
- Long Term Disability Certificate of Insurance
- Short Term Disability Certificate of Insurance
Term Life Benefit Certificates
- One America Term Life Certificate - Elected Officials
- One America Term Life Certificate - Full Time Employees
- One America Voluntary Term Life Certificate - Elected Officials
- One America Voluntary Term Life Certificate - Full Time Employees
Employee Assistance Program
- One America Service Flyer
- One America Guide to Using Guidance Resources Online
- One America Work-Life Benefits
- One America Employee Assistance Program FAQ
Retirement
- Hoosier START Plan Highlights
- Retirement Small Increases Summary
- Hoosier START Website - The Hoosier Save Today and Retire Tomorrow (START) Plan is a powerful tool to help you reach your retirement dreams. As a supplement to other retirement benefits or savings that you may have, this voluntary. Plan can help you to save and invest extra money for retirement... tax-deferred!
- Indiana Public Retirement System Website - PERF - With approximately $22.2 billion in assets under management at fiscal year-end 2010, the Indiana Public Retirement System (INPRS) is among the largest 100 pension funds in the United States. The fund serves the needs of more than 500,000 members and retirees representing more than 1,400 employers including public universities, school corporations, municipalities and state agencies.