Forms and Benefits

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Medical, Vision, and Dental Insurance Benefits

• Blue Cross Blue Shield of Michigan
• MESSA (Faculty)
• Delta Dental of Michigan
• EyeMed (Staff)
• Vision Service Plan (Faculty)
• BASIC

Flexible Spending Account (FSA)

• FSA BASIC Presentation
• FSA Enrollment Form
• IRS Eligible Expenses
• FSA Child Care Plan

Family Medical Leave Act (FMLA)

• FMLA Guidelines and Physician Statement
• FMLA for Employee Form
• FMLA for Family Member

Michigan Public School Employees Retirement System (MPSERS)

• MPSERS – Office of Retirement Services

Payroll

• Time Card & Leave Time Adjustment Form
• DW-4 Detroit
• W-4 Federal
• W-4 State
• 403B Tax Sheltered Annuity Form
• Roth 403B Form