City of Lincoln
Personnel Department
Risk Management Division
Personnel Department
Risk Management Division
PAGE & X
LCEA, E
Fire
Police
DSS, M
ATU
Athorization for Release of Protected Health Information
Blue365 - Your resource for living healthier
Case Management Transition Form
Drug Formulary (April 2012)
Enrollment Form
Explanation of Benefits
Extension of Coverage Request for Extended Eligibility to Age 30
Health Care Reform Benefits for Preventive Services
International Claim Form
New Prescription Order Form
Notice of Privacy Practices
Online Member Services
Prescription Drug Claim Form
Preventive Guidelines
Schedule of Benefits Summary
Subscriber's Claim Form - Non-Participating Provider
Subscriber's Claim Form - Used when filing claims to another PCPS plan
Vision Claim Form
Customer Service number: 1-800-642-8980 or www.bcbsne.com
Group Enrollment/Change or Waiver Form
Plan Highlights
Customer Service number: 1-800-487-5553 or www.ameritasgroup.com
Enrollment/Change or Waiver Form
Vision Plan
Customer Service number: 1-866-289-0614 or www.eyemedvisioncare.com
Claim Form
Enrollment Form
Flexible Spending Account Flyer
Health Care Reform Act
Over the Counter Drugs and Medicines Information
Over the Counter Legislation Update
Payflex Card Flyer (Current Participants)
Payflex Card Flyer (New Participants)
Quick Reference Guide
Summary of Plan Description
Summary of Material Modifications
Customer Service number: 1-800-284-4885 or www.healthhub.com
Change Form
Claim Form
On-Line Enrollment Form
Summary Program Description
Transportation Benefit Plan
2011 Annual Enrollment Letter
Basic Life Coverage Booklet
Employee Travel Assistance Program
Hartford Personal Health Application
Life Conversations Brochure
New Hire Enrollment Form
Supplemental Life Brochure
Supplemental Life Insurance and Accidental Death & Dismemberment Benefit Highlight Sheet
Allstate Voluntary Benefits
Prudential Brochure
Contact number: 402-484-3826 or Email: Vera Schneider
Benefit Brochures and Videos
Accident and STD Claim Form - 651K
Allstate Corporate Information - 52K
Accident Insurance - 973K
Critical Illness Claim Form - 57K
Critical Illness Insurance - 454K
Critical Illness Wellness Claim Form - 36K
Enrollment Information - 34K
Voluntary Short Term Disability - 394K
Call Center: 877-282-0808; M-F; 7:00am - 4:00pm; or Email: Karen Keller
Personnel Homepage
Risk Management