Employee Benefits Forms & Brochures

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5 E. South Street, Hernando, MS 38632
PH: (662) 429-5271 | FX: (662) 429-4198

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Employee Benefits Information & Forms

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662.449.7112

Documents

Applications

Change in Status Form
State of MS Health Application
State of MS Life Insurance Application
Delta Dental Enrollment Form.pdf

Service Providers Contact Information

Employee Benefits Contact Info.pdf

Benefit Legal Documents

Affordable Care Act/Marketplace Information
COBRA
HIPPA Privacy Notice
Notice of Enrollment Rights

Dental & Vision

2021 Delta Dental.pdf
Delta Dental Enrollment Form.pdf
2021 Eye Med Flyer.pdf
2021 Eye Med Summary.pdf
2021 Eye Med Questions.pdf

Health

Know Your Benefits BCBS of MS
Active Health Guide (Maternity Management Program)
Employee Assistance Program (effective 1-1-2021)
Amwell (BCBS Online Doctor Visits)
Coverage Options Summary-Base/Select
Glossary of Medical Terms
Health Insurance Reference Guide
Health Rates
BCBS_2021 HEALTH RATES.pdf
Prescription Coverage Information
Wellness/Preventive Coverage Guidelines

MS State Life Insurance (Minnesota Life)

Beneficiary Designation Form
Beneficiary Designation Online Instructions
Contact Minnesota Life(Securian)
Conversion Brochure
Evidence of Insurability-Late Enrollee
Life Insurance Certificate
Plan At A Glance
Portability Packet for Life Insurance
State Life Insurance Rates

American Fidelity

Schedule Appointment w/h Our Representative
American Fidelity Enrollment Site
American Fidelity Mobile App
Annuities Change of Beneficiary Form
Boston Mutual Life Insurance
Change of Beneficiary Form
Texas Life Insurance

American Fidelity Claim Forms

Accident Insurance Claim Form
Cancer Insurance Claim Form
Critical Illness Insurance Claim Form
Dependent Care Account Claim Form
Disability Insurance Claim Form
Flexible Spending Account Claim Form
Gap Insurance Claim Form
Hospital Indemnity Insurance Claim Form
Life Insurance Claim Form

Optional Services

LegalShield - IDShield Application
LegalShield - IDShield Information
TELAMED

MACS & MPACT (MS College Savings)

MACS & MPACT PROGRAM

MS Deferred Compensation

Schedule Appointment w/h Our Representative
Plan Information

DCS is committed to providing a work environment that is free of discrimination. It is the policy of DCS that all applicants and employees are entitled to equal employment opportunity regardless of race, color, religion or creed, gender (includes pregnancy or related medical conditions), national origin, age, disability, veteran status or other protected characteristics as required by local, state and federal law.

For general information, please visit www.desotocountyschools.org or call 662.429.5271.

The DeSoto County School District is also committed to providing a website that is accessible to the widest possible audience, regardless of technology or ability. This website endeavors to comply with best practices and standards defined by Section 508 of the U.S. Rehabilitation Act. If you would like additional assistance or have accessibility concerns, please visit the website accessibility page. We are always striving to improve the accessibility standards of our website.

ACCESSIBILITY POLICY

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