Henderson County Schools Home > Departments > Human Resources

DENTAL -

Health Resources Subscriber Dental Enrollment Application - This application for coverage can be used during open enrollment, when you are a new hire or when you have a qualifying event.

Dental Health Options Information Brochure - This brochure explains the dental coverage.

Children's Orthodontic Rider - This document explains orthodontic coverage for children under the age of 19.

Provider Dentists - Dentists that are part of the Health Resources network.

Dental Premium Rates 2011

Health Resources, Inc. (Open Enrollment - 1st week of November)
https://www.hri-dho.com/home.aspx

VISION -

Henderson County Vision Employee Application - This application for coverage can be used during open enrollment, when you are a new hire, or when you have a qualifying event.

Henderson County Vision Plan 23 Summary - This document explains the vision insurance coverage.

Henderson County Vision Provider Directory - Doctors that are part of the Vision insurance network of providers.

Vision Premium Rates 2011

Group Insurance Beneficiary Form

Kentucky Employees' Health Plan Handbook - Please refer to pages 58 - 60 of the handbook file to find information about eligible health plan participants and dependent information. If you look at the actual document page numbers (at the bottom of each page), the numbers are 56 - 58.

Forms listed below - once complete - MUST be sent to Jamie Newton at the Board Office. Do NOT send these directly to the companies as they will not be able to process them. Please contact Jamie Newton at (270) 831-5000 if you have any questions.

HEALTH -

Employees who are adding coverage because of a qualifying event and have previously waived coverage can complete the 2010 KEHP application.

To add coverage if an insurance plan is already in effect for 2010, please complete this add form. Additional documentation will be required (i.e letter of creditable coverage).

To drop coverage please complete this drop form. Additional documentation may be required.

Employees who need to be reimbursed from their employer HRA or own Flexible Spending Account should complete the Humana HRA/Flex claim form.

Humana 1-877-597-7474 (Open Enrollment--Fall of Each Year)
http://apps.humana.com/egroups/commonwealthky/home.asp

DENTAL -

Health Resources Subscriber Dental Enrollment Application - This application for coverage can be used when you are a new hire or have a qualifying event.

Dental Health Options Information Brochure - This brochure explains the dental coverage.

Children's Orthodontic Rider - This document explains orthodontic coverage for children under the age of 19.

Provider Dentists - Dentists that are part of the Health Resources network.

Dental Premium Rates 2011

Health Resources, Inc. (Open Enrollment - 1st week of November)
https://www.hri-dho.com/home.aspx

VISION -

Henderson County Vision Employee Application - This application for coverage can be used when you are a new hire or have a qualifying event.

Henderson County Vision Plan 23 Summary - This document explains the vision insurance coverage.

Henderson County Vision Provider Directory - Doctors that are part of the Vision insurance network of providers.

Vision Premium Rates 2011

SICK BANK -

Sick bank open enrollment is held in November. If you are interested in joining the sick bank please fill out the
attached application. Please note there are different applications for classified and certified. If an employee no
longer wants to participate in the sick bank, a cancellation must be submitted in writing to Shelia Redmon.

Certified Sick Leave Bank Authorization Form

Classified Sick Leave Bank Authorization Form

Request to Donate Sick Leave

Employee must complete Application for Family Leave.

Doctor must complete Certification by Physician form.

Change of Name or Address

When an employee changes an address or name, all of the appropriate forms must be completed and returned to Katie Duncan to ensure a timely update of personal information.

Henderson County Name-Address Change Form (ALL employees)

Health Insurance Update Form 2010 (ALL employees)

HRI Dental Insurance Update Form (Covered employees only)

KTRS [Kentucky Teacher Retirement System] Change of Address (KTRS covered employees only)

KRS [Kentucky Retirement System] Change of Address (KRS covered employees only)

American Fidelity Address Change Form (For employees who have American Fidelity products)

American Fidelity Name Change Form (For employees who have American Fidelity products)

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Workers' Compensation

Within 24 hours of the incident, forms must be completed and returned to Adrienne Kinnin or Jamie Newton.

If medical treatment outside of school premises is sought, complete the following:

Internal Incident Report

Medical Consent Form

Notice of Designated Physician Form

If medical treatment is not sought outside of school premises, the only form that needs to be completed is the Internal Incident Report.

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Retirement
     Contact Adrienne Kinnin for more information.

     Kentucky Teachers Retirement System - Certified
       (800) 618-1687 or (502) 848-8500
            http://ktrs.ky.gov

     Kentucky Retirement System - Classified
       (800) 928-4646 or (502) 564-4646
            http://www.kyret.com

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FMLA - Family Medical Leave Act