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

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
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 2023

Blue Cross Preferred BCI PPO (PDF)
St. Luke's Health Partners Plan (SLHP)
Blue Cross Basic PPO (PDF)
Blue Cross Vision VSP

Plan Summary Documents 2023

Blue Cross Preferred BCI PPO (PDF)
St. Luke's Health Partners Plan (SLHP)
Blue Cross Basic PPO (PDF)
VSP Vision Summary (PDF)

Plan Documents 2022

St. Luke's Health Partners Plan (SLHP)
Blue Cross of Idaho PPO (PDF)
Blue Cross Basic PPO (PDF)
VSP Vision

Plan Summary Documents 2022

St. Luke's Health Partners Plan (SLHP)
Blue Cross of Idaho PPO
Blue Cross Basic PPO (PDF)
VSP Vision Summary

Employee Exchange Notice

Employee Exchange Notice (PDF)

Dental Insurance

Plan Documents

Dental Blue Connect (PDF)
Delta Dental 2021
Delta Dental 2022

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)

Family & Medical Leave Act

FML Employee Rights Poster (PDF)
FML Employee Rights Poster (Spanish) (PDF)