Insurance

2018/2019 Open Enrollment

Health Plan Documents and Guides

  1. 2018 YCT Enrollment Guide-Interactive
  2. 2018.2019 Chino Valley Health Insurance Election Form FILLABLE
  3. 2018.2019 What is New
  4. Coming Soon Teladoc
  5. Requesting a Teladoc Video Consult - Online
  6. Gym Reimbursement Program Flyer
  7. YCT Gym Membership Refund Form 2018.07.01
  8. 2018.2019 Town of Chino Valley Benefits Summary
  9. SBC-Premier Plan
  10. SBC-Basic Plus Plan
  11. SBC-HDHP Plan
  12. HSA Additional Contribution Payroll Deduction Form
  13. HSA Employee Enrollment Form
  14. 2018.2019 Flexible Spending Account Election Form
  15. OptumRxSelectStandard
  16. Securion Initial Life Insurance Enrollment Packet - YCT Town of Chino Valley
  17. Securion Life Insurance Enrollment Worksheet

2018/2019 Benefit Videos


Health Insurance Forms

  1. Mid Year Enrollment Changes Allowed Under YCT Plan
  2. Medical and Dependent Care Reimbursement Form

Health Savings Account

A High Deductible Health Plan (HDHP) along with a Health Savings Account (HSA) can give you more flexibility and control of your health care dollars before taxes and save you even on your taxes.  This plan will provide the preventative wellness benefits that you are used to.  With the HSA you have the opportunity to build your balance from year to year for use into your retirement.  Get more information by accessing the following documents:

  1. HSA Additional Contribution Payroll Deduction Form
  2. HSA Employee Enrollment Form
  3. HSA Health Equity Brochure
  4. HSA FAQs

Life Insurance

  1. Securion Initial Life Insurance Enrollment Packet - YCT Town of Chino Valley
  2. Securion Life Insurance Enrollment Worksheet
  3. Securion Life Insurance Evidence of Insurability Form

ICMA-RC (Forms)

  1. 2017 457 ICMA Deferredc Comp Contribution Form
  2. 457 Loan Refinance Application Form (PDF)