Skip to main content

FORMS

Health Insurance Forms

Blue Cross Medical Claim Form
Blue Cross Prescription Reimbursement Form
Verification of Insurance

Dental Insurance Forms

Delta Dental Claim Form

Flexible Spending (FSA)

Medical Reimbursement Form
Dependent Care FSA Reimbursement Form
Reimbursement Fax Cover Sheet

Mid Year Change of Status/Election Form

Peak1 FSA Direct Deposit Form
Summary Plan Description

New Enrollment Guide

Deferred Compensation

General Employees

All enrollments, contribution changes, and beneficiary designations for the 457 must be completed at www.lfg.com.

Fire Contract Employees

All enrollments, contribution changes, and beneficiary designations for the 457 must be completed at www.lfg.com.

Police Contract Employees

New Enrollment Form (PDF)
Contribution changes and beneficiary designations must be completed at www.empower-retirement.com.

Life Insurance and Long Term Disability

Medical History Statement

Payroll Forms

Idaho W-4  You can also make W-4 changes directly through Employee Self Service
Federal W-4 New for 2020!
IRS Withholding Calculator (Federal Taxes)
City of Boise Direct Deposit Form
 (PDF)
Payroll Calendars
Leave Accrual Schedule (PDF)

PERSI

PERSI 401(k) Enrollment Form/Monthly Deduction Change Form (PDF)
PERSI Beneficiary Change Form (PDF)

Other Forms

Family Medical Leave Request Form (PDF)
Employee Incident/Injury/Exposure Reporting Form   
Fire Dept MRF-1 (PDF)


DOCUMENTS

Health Insurance

Plan Documents

Blue Cross Preferred PPO (PDF)
Blue Cross Economy PPO (PDF)
Blue Cross Basic PPO (PDF)
Blue Cross VSP

Plan Summary Documents

Blue Cross Preferred PPO (PDF)
Blue Cross Economy PPO (PDF)
Blue Cross Basic PPO (PDF)
VSP Vision Summary (PDF)

General Employee Medical Insurance Comparison Matrix

2020 Health Plan (Medical, Vision) (PDF)
2020 Basic Health Plan (PDF) 
2020 Dental Plans (PDF)

Employee Exchange Notice

Employee Exchange Notice (PDF)

Dental Insurance

Plan Documents

Dental Blue Connect (PDF)
Delta Dental

Plan Summary Documents 

Delta Dental - Comprehensive (PDF)
Delta Dental - Core (PDF)
Delta Dental - Preventive (PDF)
Dental Blue Connect (PDF)

Life Insurance, Accidental Death and Dismemberment, Dependent Life

General Employees

Basic Life Summary (PDF)
Additional Life Summary (PDF)
Additional Life Certificate (PDF)
Additional AD&D Certificate (PDF)

Contract Employees

Basic Life Summary (PDF)
Additional Life Certificate (PDF)

Long Term Disability

General Employees

LTD Summary (PDF)
LTD Certificate (PDF)

Contract Employees

LTD Summary (PDF)
LTD Certificate (PDF)

Handbooks

PERSI Member Handbook (PDF)

Payroll

Paystub Overview (PDF)