Insurance Enrollment Information

Following are insurance enrollment forms and information for your employment with the City and Borough of Sitka. All links require Adobe Acrobat Reader except as indicated.

• Premera Blue Cross Plan Booklet

 Copy available in the Human Resources Office

 Check out Premera Blue Cross Premera Blue Cross website.

• Premera Blue Cross Enrollment Form

 For enrollment in the group health, dental and vision insurance program.

• Premera Blue Cross Waiver Form

 Should you not want to enrol in the group health plan.

• Premera Blue Cross Price Sheet

 Cost for various levels of insurance and basic description of current benefits.

• COBRA - Employee Notification
• HIPAA Portability/Women's Cancer Act Notice
• HIPAA Privacy Notice
• LifeWise Assurance Booklet

 Available in the Human Resources Office

 Check out LifeWise Assurance website.

• LifeWise Assurance - Basic Group Life Enrollment Form

 For Life and Accidental Death insurance provided by the City and Borough

• LifeWise Assurance - Voluntary Life Enrollment Form

 For the voluntary component of this life insurance plan. $50,000 guaranteed issue.

• LifeWise Assurance Price Sheet

 Costs for Basic and Voluntary Life Insurance

• LifeWise Beneficiary Change Form
• AFLAC/Heritage Supplemental Insurance Packets

 Available in the Human Resources Office