Payroll

Payroll & Benefits Orientation Information

This document includes information that all new hires need to know regarding pay and benefits. If you have any questions, please feel free to contact the Payroll & Benefits Office for further information.

Forms for Employees that Qualify for Benefits:

Sick Bank Enrollment Form - (You have 30 days from your date of hire to join the bank)

[The Sick Bank provides job and income protection in the event you have an illness or injury and have exhausted all of your leave. There is a six-month waiting period before benefits become active for most employees. VRS Hybrid employees do not have a waiting period, but can only be enrolled for one year; after one year of employment, Hybrid employees have short term disability coverage that goes into effect.
Please refer to SB Policy Section 5-7.5 for more details.]

Please reach out to Gallagher to set up Benefits such as: Health Insurance and Optional Products [Dependent Care Account (DCA), Flexible Spending Account (FSA), Limited Purpose Flexible Spending Account with HSA, Ameritas Dental, Ameritas Vision, Unum Accident Insurance, Unum Hospital Indemnity, Unum Short Term Disability, Chubb Group Critical Illness, Chubb Lifetime Benefit Term Insurance, & LegalShield]

*If you do not have Gallagher's information, please reach out to the Payroll & Benefits office directly to find out how to enroll in benefits at 540-382-5100 or payrollbenefits@mcps.org.

For employees that qualify for VRS Benefits:

• Starting Your Hybrid Plan Adventure
• VRS Group Life Insurance Certificate
• VRS Beneficiary Designation Form
• Continuation Form
• Hybrid ICMA-RC Beneficiary Designation Form
• Securian / Minnesota Optional Life Insurance Booklet 
• Securian / Minnesota Life Enrollment Form / Waiver
• Securian / Minnesota Life Evidence of Insurability

Other Information:

• Summary of Benefits
• Employee Hourly Time Sheet
• Employee 12 month Time Sheet
• 2024-2025 Payroll Cut off dates for AA entry

**Life Event Changes must be submitted to the Payroll Office within 30 days of the event with documentation**
[Life Event Changes include: Birth of Child, Marriage, Divorce, Loss of Coverage]

2023 - 2024 MCPS Benefit Booklet

Want to know which benefits would work best for you? 

 

Anthem Enrollment Application

• Lumenos Detail Benefit Description
• HMO Detail Benefit Description
• PPO Detail Benefit Description

*If you are a New Hire, you must enroll with Gallagher unless otherwise instructed.
Please contact the Payroll & Benefits Office at 540-382-5100 if you have any questions or concerns.*

Forms:

• Family Status Change Form
• Anthem Member Change Form
• Anthem Enrollment Application
• HSA - UMB Bank Enrollment Form
• HSA Payroll Deduction Form
• Health Insurance Pre-Tax Conversion Form

Retiree Forms:

• Retiree Anthem Enrollment Application
• Retiree ACH Debit Authorization Form

Information on the Health Savings Account (HSA):

• HSA FAQ
• HSA Myths & Facts
• HSA Web Access
• HSA Mobile App
• HSA Eligible Expense List
• HSA - UMB Bank Investment Options 
• HSA - UMB Bank Beneficiary Designation Form

Maximum Annual HSA Contribution Limits
	Total for 2023	Total for 2024
Employee Only	$3,850	$4,150
Employee Plus Dependents(s)	$7,750	$8,300

Visit Flexible Benefit Administrators web page for more information.
Forms can be found here as well.

General Information:

• How to Find a Doctor - Anthem
• Anthem Machine-Readable Files
• Anthem Anywhere App
• For information on prescription drugs follow this link: Anthem Prescription Drug Lists and select "National Drug Lists/3 tier" 
• Information on Marketplace Coverage Options
• COBRA General Notice

**Life Event Changes must be submitted to the Payroll Office within 30 days of the event with documentation**
[Life Event Changes include: Birth of Child, Marriage, Divorce, Loss of Coverage]

2023 - 2024 MCPS Benefit Booklet

Want to know which benefits would work best for you? 

Try ALEX, an interactive guide to employee benefits!

List of Offered Cafeteria 125 Products:

• Dependent Care Account (DCA)
• Flexible Spending Account (FSA)
• Limited Purpose Flexible Spending Account with HSA
• Ameritas Dental
• Ameritas Vision
• Unum Accident Insurance
• Unum Hospital Indemnity
• Unum Short Term Disability
• Chubb Group Critical Illness
• Chubb Lifetime Benefit Term Insurance
• LegalShield

Contact Information:

Benefit	Carrier	Phone Number	Web Address
Medical Plan	Anthem	1-800-451-1527	https://www.anthem.com/
Health Savings Account (HSA)	Flexible Benefit Administrators	1-800-437-3539	https://fba.wealthcareportal.com/Page/Home
Flexible Spending Account (FSA) & Limited	Flexible Benefit Administrators	1-800-437-3539	https://fba.wealthcareportal.com/Page/Home
Dependent Care Account (DCA)	Flexible Benefit Administrators	1-800-437-3539	https://fba.wealthcareportal.com/Page/Home
Dental Plan	Ameritas	1-800-487-5553	https://www.ameritas.com/
Vision	Ameritas / VSP	1-800-487-5553	https://www.ameritas.com/
Critical Illness	Chubb	1-866-445-8874	https://www.chubb.com/
Lifetime Benefit Term Insurance	Chubb	1-855-241-9891	https://www.chubb.com/
Voluntary Short Term Disability	Unum [Policy # 0637210]	1-800-858-6843	https://www.unum.com/
Accident Insurance	Unum	1-800-635-5597	https://www.unum.com/
Hospital Indemnity Insurance	Unum	1-800-635-5597	https://www.unum.com/
Legal and ID Theft Insurance	LegalShield	1-877-825-3797	https://www.legalshield.com/
Texas Life Insurance(Grandfathered Plan)	Texas Life Insurance	1-800-283-9233	https://www.texlife.com/

Ameritas Enrollment Application:

• Dental/Vision Enroll/Change/Waiver (Send the application to the MCPS' Payroll Dept. for processing)

Flexible Spending Accounts (FSA):

• General FSA Outline
• MCPS Employee FSA Spending Guide
• FSA Eligible Products List
• FSA Medical Reimbursement Claim Form

LIMITED Purpose Flexible Spending Accounts:

• Limited FSA Information
• Limited FSA Medical Reimbursement Claim Form

Dependent Care Accounts (DCA):

• DCA Employee FAQ
• DCA Reimbursement Claim Form

Other Information / Forms for FSA & DCA:

• Mobile App
• Web Access
• Online Claims Submission
• Grace Period FAQ
• Eligible Expense List

Visit Flexible Benefit Administrators web page for more information.
Forms can be found here as well.

Chubb Forms:

• Chubb Lifetime Benefit Term Insurance Cancel Form
• Chubb Lifetime Benefit Term Insurance Beneficiary Change Form
• Chubb Critical Illness Claim Form
• Chubb (Critical Illness) Wellness Benefit Form
• Chubb Wellness Benefit Flyer

Unum Forms:

• Unum - How to File a Claim
• Unum - Maternity FAQ Flyer
• Unum - Voluntary Short Term Disability Claim Form Policy #0637210
• Unum Hospital Indemnity Claim Form
• Unum Accident Claim Form
• Unum (Accident) Wellness Claim Form

Optional Life Insurance through Virginia Retirement System (VRS):

• Securian / Minnesota Life Optional Life Insurance Information Booklet
• Securian / Minnesota Life Enrollment Form / Waiver

Other Optional Benefits:

• MCPS Sick Leave Bank Enrollment Form

Montgomery County Education Foundation

• What is the Montgomery County Education Foundation?
• MCEF Donations Payroll Deduction Form

Plan your Future!

VRS Website

VRS Login

 Plans:

• Plan 1: A defined benefit plan for employees hired before July 1, 2010, and vested as of
• January 1, 2013
• Plan 2: A defined benefit plan for employees hired:
  • After July 1, 2010, and before December 31, 2013; or
  • Before July 1, 2010, and were not vested as of January 1, 2013
• Hybrid: A combined defined benefit and defined contribution plan for members hired on or after January 1, 2014
  • Starting Your Hybrid Plan Adventure
• MCPS VRS ICMA-RC Representative Contact Sheet
• VRS ICMA-RC Representative Plan Specialists

VRS Plan Comparison

VRS Group Life Insurance Certificate

Forms:

• VRS Beneficiary Designation Form 
• Continuation Form
• Hybrid ICMA-RC Beneficiary Designation Form

Optional Life Insurance through Virginia Retirement System (VRS):

• Website
• Fax Number: 866-496-0565
• If you would like a Summary of your VRS Group Life Plan, please text 70774 with the message "VRS"
• Securian / Minnesota Life Optional Life Insurance Information Booklet
• Securian / Minnesota Life Enrollment Form / Waiver
• Securian / Minnesota Life Evidence of Insurability

As a VRS Hybrid Plan employee you may be eligible to receive Short Term Disability (STD) benefits while you are absent from work due to an approved illness or disability.

The Hybrid Disability Plan is administered by AnthemLife and provides some income protection if you are unable to work due to disability. As an employee in the VRS Hybrid Retirement Plan, you are automatically enrolled in this program, which meets the requirements of Title 5.1 of the Code of Virginia.

The links provided below will take you directly to important documents regarding the Hybrid Disability Plan, including a description of the benefits, information on how to report a claim, employee handbook, FAQ, coverage certificates, and other resources.

Montgomery County Public Schools' VACORP group number: AL00006723

Quick Link Resources for Employees:

• Short Term Disability under the VRS Hybrid Plan
• Hybrid Short Term Disability Example
• How to File Hybrid Short Term Disability MCPS

Additional Information for Hybrid Employee Coverage:

 VRS HYBRID Disability Coverage

• Hybrid Employee Handbook
• Employee FAQ
• STD Benefits at a Glance
• STD Certificate of Coverage
• LTD Benefits at a Glance
• LTD Certificate of Coverage
• Reporting Claims via Phone
• Reporting Claims Online
• Anthem Resource Advisor
• Perks at Anthem

General Information on 403(B) & 457(B) Investments

403(B) & 457(B) Authorized Vendors

Salary Reduction Agreement Form

This benefit is 100% paid by MCPS!

• Standard Group LTD Certificate
• Standard Group LTD Detail Policy
• LTD Claim Form

You must report any work-related injury to Company Nurse.

Quick Guide to Workers' Compensation Protocol

Instructions for reporting incidents to the Company Nurse hotline: 888-770-0925

If treated by a Panel Physician, you MUST obtain a Return to Work Note before you can return to work. If the Panel Physician lists any restrictions/modified duty, it must be approved by Human Resources or Operations before you can return to work.

You must submit a copy of your return to work note to your Supervisor and Payroll following every medical appointment.

If you need to fill a prescription, use the ExpressScripts First Fill form.

W/C Prescription Form

Our Third Party Company that reviews, handles, & determines if injury claims are compensable:

VACORP Contact Information:

1819 Electric Road, Suite C 
Roanoke, VA 24018

Phone: 1-888-822-6772

Fax: 1-877-212-8599

Information for the Health Insurance Advisory Committee

Application for committee membership