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Internal Human Resource Forms
2019-2020 Summary of Benefits and Coverage (SBCs)
- Priority High Deductible Health Plan (HDHP) with HSA
- Understanding the HDHP HSA
- Priority HMO 100% High Plan
- Priority Health Medical Advantage (MAPD) Summary - Retirees
- Notice of Nondiscrimination and Language Assistance Services
- Glossary of Health Coverage & Medical Terms
- Delta Dental - ACT, L&P ACT, GME-CT, FIRE, & L&P BU
- Delta Dental - Police & GME
- Vision Plan
Internal Forms for Current City Employees
PAYROLL FORMS
- 2020 FSA Enrollment Form
- Authorization for Automatic Deposit
- Authorization for Automatic Deposit - ACT 345
- W-4 Michigan Withholding Allowance Form
- W-4 Federal Withholding Allowance Form 2019
CHANGE FORMS
- Employee Address/Name Change Form
- Priority Health Insurance Change Form
- Opt-Out Form - Health Insurance
- MetLife Vision/Life Change Form
- Delta Dental Insurance Change Form
- HSA Salary Redirection Authorization
- MERS Beneficiary Change Form
- ICMA-RC 457 Deferred Comp. Change Form
- ICMA-RC 457 Deferred Comp. Beneficiary/Name & Address Change Form
- ICMA-RC: Change Current and Future Allocations
- MassMutual 457 Deferred Comp. Change Form
- MassMutual 457 Deferred Comp. Beneficiary/Name & Address Change Form
- MassMutual: Change Current and Future Allocations
REIMBURSEMENT FORMS
- Section 125 Plan - Dependent Care Claim Form
- Section 125 Plan - Limited Purpose Health FSA Claim Form
- Educational Incentive Plan Request Form
- MERS Health Care Savings Plan (HCSP) Reimbursement Form
EMPLOYEE INFORMATION
- Employee Assistance Program
- Injury Reporting Form
- FMLA Request for Leave Form
- Personal Leave of Absence Form
- City of Traverse City Notice of Privacy Practices
Michigan Municipal League Tuition Incentive Program
This page last updated on 11/9/2019.