Benefits Open Enrollment Materials

Open Enrollment runs from 8.11.25 - 8.15.25.

2025-2026 Certified Staff Benefit Summary and Rates

A detailed summary of medical, dental, and vision insurance plans for certified staff at Jay School Corporation for the 2025-2026 period.

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2025-2026 Support Staff Benefit Summary and Rates

This document provides an overview of medical, dental, and vision benefits, including contributions and premiums for support staff at Jay School Corporation from 2005 to 2026.

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PHP Enrollment Form

This document is an enrollment form for employees of Jay School Corporation to select benefits and provide personal and dependent information for health coverage.

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Section 125 Form

Fill out this form if you do not currently have our insurance but are now electing coverage and wish to have your insurance premiums withheld pre-tax.

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HSA Application

(Optional) Fill out if you have "Plan 2 or Plan 3" and wish to contribute to a Health Savings Account

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Life Insurance Beneficiary Form

Must Complete

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Dental Eligibility Enrollment/Update Form

Optional

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Vision Enrollment/Change Form

Optional

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