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City of Lincoln
City of Lincoln
Human Resources Department
Risk Management Division

City Benefit Information for plan year 11/01/2014 - 10/31/2015

Welcome all eligible employees to our on-line open enrollment site. We encourage you to utilize the forms and information on this page, to quickly sign up for City of Lincoln benefits.

For the new City plan year that begins November 1st 2014 and goes through October 31st 2015 we have on this web page all of the forms and information you will need for this years open enrollment. Also, Please keep in mind that All open enrollment information must be received in the Human Resources Department by September 19, 2014.

This year: All coverages will continue as they have except for Flex-Plan. You do not need to complete a Health, Dental or Vision form if you are not making any additions, deletions or other changes to your coverages. If you are making changes to these coverages you will have to complete a form by printing it, completing it fully and then either mailing, or bringing this in to the Benefits area of the Human Resources Department, County City Building at 555 S. 10th Street, Room 302 Lincoln, NE 68508. Also we are completing our enrollment for Flex-Plan on-line just as we did last year, yet the total amount you may put aside for unreimbursed medical has been reduced to $2,500.

Finally, should you have any questions for us in the Human Resources Department, please don't hesitate to e-mail or call us as listed below.

Bill Thoreson Phone: 441-7883 Email:

Paula Lueders Phone: 441-7878 Email:

Bill Kostner Phone: 441-7671 Email:

Imputed Income

All links are in PDF Format

City of Lincoln 2014 Open Enrollment Meeting Schedule and Information

City of Lincoln November 1, 2014 - October 31, 2015 Benefit Rates:

ATU DSS & M Fire LCEA & E PAGE Police X

Blue Cross / Blue Shield

Athorization for Release of Protected Health Information
Blue365 - Your resource for living healthier
Breastfeeding Support, Supplies and Counseling
Case Management Transition Form
Contraceptive Drugs and Methods Pharmacy List
Contraceptive Methods and Counseling
Deciding Where To GoNew
Drug Formulary (July 2014)
Enrollment Form New
Explanation of Benefits
Extension of Coverage Request for Extended Eligibility to Age 30
Health Care Reform Benefits for Preventive Services
International Claim Form
Nebraska Urgent Care & Retail Health Locations New
New Prescription Order Form
Notice of Privacy Practices
Online Member Services
Prescription Drug Claim Form
Preventive Guidelines
Prime Therapeutics Specialty Pharmacy
Subscriber's Claim Form - Non-Participating Provider
Subscriber's Claim Form - Used when filing claims to another PCPS plan
Summary of Benefits for LPU & ATU
Summary of Benefits for E & DSS & X
Summary of Benefits for M
Summary of Benefits for PAGE & LCEA
Summary of Benefits for IAFF
Vision Claim Form
Customer Service number: 1-800-642-8980 or

Ameritas - Dental

Group Enrollment/Change or Waiver Form
Plan Highlights
Summary Plan Description (2013)
Customer Service number: 1-800-487-5553 or

Ameritas - EyeMed

Enrollment/Change or Waiver Form
Vision Plan
Summary Plan Description (2013)
Customer Service number: 1-866-289-0614 or


On-Line Enrollment Form
FSA Open Enrollment Instructions
FSA Welcome Letter
Flexi-Card Employer Overview
Flexi-Card / Direct Deposit Authorization Form
Employer Handbook
Flexible Spending Arrangement Claim Form
Flexplan Day Care FSA Receipt for Service
Flexible Spending Arrangement Enrollment Form
Flexi-Card Employee Overview
Flexible Spending Arrangement Enrollment Guide
Letter of Medical NecessityNew
Parking Enrollment Form
Parking Reimbursement Claim Form
How to submitt a Recurring Day Care ClaimNew

Hartford Life

2014 Annual Enrollment Letter
Basic Life Coverage Booklet
Beneficiary Assist Program
City of Lincoln Benefits Enrollment Form
Estate Guidance Will Services
Funeral Planning and Concierge Services
Group Life and/or Accidental Death & Dismemberment Claim Forms for Employee or Dependent
Group Life Portability Outline
Life and Accidental Death and Dismemberment Insurance
Personal Health Application
Supplemental Life Brochure
Supplemental Life Insurance and Accidental Death & Dismemberment Benefit Highlight Sheet
Travel Assistance Program

Allstate Voluntary Benefits

Benefit Brochures and Videos
Accident and STD Claim Form
Allstate Corporate Information
Accident Insurance
Critical Illness Claim Form
Critical Illness Insurance
Critical Illness Wellness Claim Form
Enrollment Information
Voluntary Short Term Disability
Call Center: 877-282-0808; M-F; 7:00am - 4:00pm; or Email: Karen Keeler

Human Resources Homepage Risk Management