Human Resources Forms and Links

 



Human Resources Forms and Links


This page is for the storage of files that may not be accessible according to the Section 508 Accessibility Standards. Port Huron Schools is in the process of re-mediating the files into an accessible format. As the files are made accessible, they will be moved to the main Human Resources page.

While the re-mediation process is occurring, these files are still available to access by this archive page, but please do not link to any files located here as they may be changed/removed at any time.

Please direct any questions about files on this page to webaccessibilitycoordinator@phasd.us


Employee Online

View Paystubs Online

Employee Online Instructions

Employee Online W-2 Instructions

Please contact the Payroll Department with issues regarding your password and questions.

Employee Forms

Name and Address Change Form

Direct Deposit Form

City Tax Form

State Tax Form

Federal Tax Form

Deferred Compensation (409A) Pay Option Election Form

Administrator Forms

Report of Vacancy Form

Additional Pay Timesheet

School Forms

Application for Volunteer/Contracted Services

Bloodborne Pathogen Training

Bloodborne Pathogen Training

District PSD History Link

http://intranet.phasd.us/psdhistory/


BENEFITS INFORMATION


MESSA Insurance


The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment

ACA Mandated Summary of Benefits and Coverage for Teachers, Secretaries and Paraprofessionals

2017-18 Insurance Cost for Teachers

2017-18 Insurance Cost for Secretaries with HSA (No Coinsurance)
2017-18 Insurance Cost for Secretaries without HSA (No Coinsurance)

2017-18 Insurance Cost for Paraprofessionals with HSA
2017-18 Insurance Cost for Paraprofessionals without HSA

MESSA ABC Plan 1 Application
MESSA Member Change Form
MESSA Beneficiary Designation Form

Life & Accident Insurance Certificate Booklet for Teachers, Counselors and Psychologists with Health Insurance
Life & Accident Insurance Certificate Booklet for Teachers, Counselors and Psychologists without Health Insurance

Long Term Disability Summary of Plan Benefits

Life Insurance Summary of Plan Benefits (Optional Insurance)
Long Term Disability Summary of Plan Benefits (Optional Insurance)
Short Term Disability Summary of Plan Benefits (Optional Insurance)
MESSA Optional Insurance Rates

Who Can Be An Eligible Dependent?
How To Create a MESSA Member Log-In and Password
How To View Your MESSA Benefits
List of Free Prescriptions

DELTA Dental Summary of Plan Benefits
DELTA Dental 80% Non-Coordination of Benefits Highlights
DELTA Dental 50% Coordination of Benefits Highlights

VSP Vision Summary of Plan Benefits
VSP Vision Plan Highlights

Waiver of Health Insurance - For Secretaries and Paraprofessionals
Waiver of District Contribution to Health Savings - For Secretaries and Paraprofessionals

Health Equity

Healthy Equity Website

Health Savings Account Reimbursement Form

Health Savings Account Advancement Request Form

2017 H.S.A. Payroll Deduction Authorization Form

Health Savings Account and Flexible Spending Account Information

IRS Publication 502 - Qualified Medical and Dental Expenses

IRS Publication 969 - Health Savings Accounts and Other Tax-Favored Health Plans

Priority Health Insurance

The federal Affordable Care Act (ACA) mandates that a Summary of Benefits and Coverage (SBC) document is distributed to all employees for medical plans for which they are eligible at time of enrollment. You can view this by clicking on the link below that pertains to your bargaining unit:

ACA Mandated Summary of Benefits and Coverage

Priority Health Insurance Cost 2017-18

High Deductible Plan 90% Summary of Plan Benefits
High Deductible Plan 100% Summary of Plan Benefits

Application for Plan 1 A
Application for Plan 1 B
Application for Plan 2 A
Application for Plan 2 B
Application for Plan 2 C

Priority Health Member Change Form

Waiver of District Contribution to Health Savings Account

Chemical Bank

2017 H.S.A. Payroll Deduction Authorization Form

Health Savings Accounts for Priority Health Members are established through Chemical Bank. An account can be opened at any Chemical Bank location.

CIGNA Dental Insurance

CIGNA Dental Enrollment/Change Form

Building Administrators/Central Office/Confidential's/Hourly Service Personnel, Coordination of Benefits, Dental Summary of Plan Benefits

Building Administrators/Central Office/Confidential's/Hourly Service Personnel, Non-Coordination of Benefits, Dental Summary of Plan Benefits

Teamsters Dental Summary of Plan Benefits

Food Service Dental Summary of Plan Benefits

Paraprofessional Dental Summary of Plan Benefits

Secretary with Health Summary of Plan Benefits

Secretary without Health Summary of Plan Benefits

CIGNA Life Insurance

CIGNA Beneficiary Designation Form


Mutual of Omaha

Building Administrators LTD Summary of Benefits

Building Administrators Life Insurance Policy

Central Office/Confidentials/Service Personnel LTD Summary of Benefits

Central Office/Confidentials/Service Personnel Life Insurance Policy

Custodians LTD Summary of Benefits

Custodians Life Insurance Policy

Food Service Life Insurance Policy

Secretary LTD Summary of Benefits (20+ Hours)

Secretary LTD Summary of Benefits (10 - 19 Hours)

Secretary STD Summary of Benefits (20+ Hours)

Secretary STD Summary of Benefits (10 - 19 Hours)

Hourly Service Personnel Life Insurance Policy

SET SEG

Paraprofessional/Secretary Life Insurance Policy

EyeMed Vision Insurance

EyeMed Enrollment/Change Form

Family Medical Leave Act

Employee Rights under FMLA

FMLA Questions and Answers

Federal Mandates

403(B) & 457 Information

403 (b) Plan by MidAmerica

Notice of Universal Availability Eligibility to Contribute to 403 (b) / 457 Plans


403(b) Plan Highlights

403(b) Salary Reduction Agreement

457 Plan Highlights

457 Salary Reduction Agreement

457 Plan Deferred Compensation Option through ORS

Office of Retirement Services (ORS)

Office of Retirement Services Website


ORS Beneficiary Election Form

ORS Name and Address Change Form



Staff Calendars by Classification

Return to Work and Holiday Schedules

2016-17 Start and End Dates
2016-17 Non Duty Days

Staff 2016-2017 Calendars and Pay Schedules


PHEA Calendar
PHEA Pay Dates Schedule
PPRO Calendar
PPRO Pay Dates Schedule
Secretary Level I Calendar
Secretary Level II Calendar
Secretary Level III Calendar
Secretary Level IV Calendar
SECR Pay Dates Schedule
Custodian Calendar
Food Service



Professional Staff Evaluation Packages

2015/2016 Evaluation Information for Each Professional Group

The packets as well as any Forms and Attachments listed have been shared with staff and require a PHASD login to view the files through the links on this page. If you are logged-in to your PHASD account, the documents should automatically open in Google Docs; otherwise, a Google login screen will appear.

Forms and Attachments

PHASD Teacher Evaluation Form 2015-2016
PHASD Teacher Consultant Evaluation Form 2015-2016
PHASD Social Worker Evaluation Form 2015-2016
PHASD SLP Evaluation Form 2015-2016
PHASD School Counselor Evaluation Form 2015-2016
PHASD OT Evaluation Form 2015-2016
PHASD Media Specialist Evaluation Form 2015-2016
PHASD Instructional Coach Evaluation Form 2015-2016
PHASD ESL Teacher/Consultant Evaluation Form 2015-2016
PHASD BIC Evaluation Form 2015-2016