FORMS
Health Insurance Forms
Blue Cross Medical Claim Form
Blue Cross Prescription Reimbursement Form
Verification of Insurance
Dental Insurance Forms
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
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 Beneficiary Change Form (PDF)
PERSI 401(k) Enrollment Form/Monthly Deduction Change Form (PDF)
PERSI Choice 401k Beneficiary Change Form (if different from PERSI Base)
Other Forms
Family Medical Leave Request Form (PDF)
Employee Incident/Injury/Exposure Reporting Form
Fire Dept MRF-1 (PDF)
DOCUMENTS
Health Insurance
Plan Summary Documents 2024
St. Luke's Health Partners Plan (SLHP)
Blue Cross of Idaho PPO
Blue Cross Basic PPO (PDF)
VSP Vision Summary
Plan Documents 2024
Blue Cross Preferred BCI PPO (PDF)
St. Luke's Health Partners Plan (SLHP)
Blue Cross Basic PPO (PDF)
Blue Cross Vision VSP
Employee Exchange Notice
Employee Exchange Notice (PDF)
Dental Insurance
Plan Documents
Dental Blue Connect (PDF)
Delta Dental 2024
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)
