Insurance Documents

Sarpy County

(Insurance benefits are generally available to employees classified as working 30+ hours per week or deemed eligible persuant to the Affordable Care Act)

Group Health Insurance:  Blue Cross/Blue Shield (1/1/19 - 12/31/19) - Information below for covered employees

Member Services: 1-888-592-8961

2019 Blue Cross/Blue Shield Premiums

Retirement Programs (2019)

Network Quick Guide.pdf

Summary of Benefits and Coverage (01-01-2019)

Schedule of Benefits (01-01-2019)

Group Health Insurance: General Information and Documents Below

Tutorial: How to find an In-Network Provider
MY BLUE:Website for creating a subscriber account
Pre-Authorization List (link to website) 

GoodRx - link for Tracking/Comparing Drug/Prescription Costs!

Naco Benefit: Term Life Insurance

Certificate of Coverage (must be enrolled in SARPY County BCBS Health Insurance)

  In-Network Partial-Self Fund: Employee Benefits Systems (EBS) (1/1/19-12/31/19)

  Claims Processing Illustration 

   Summary of Benefits and Coverage 

   Summary Plan Document

        EBS: Link to Website


Flexible Spending Accounts: General Information and Documents Below

2019 Payflex1-844-729-3539

Welcome to Payflex

Connected Claims Solutions

Keep Your Card Active

PayFlex Healthcare or Dependent Care Claim Form

PayFlex Release Form

PayFlex FSA Election Change Form

PayFlex Direct Deposit Form

Sarpy County PayFlex Reimbursement Plan

Sarpy County PayFlex Acknowledgement Resolution

Sarpy County PayFlex - Summary Plan Document (Reimbursement Plan / Cafeteria Plan)


Group Dental Insurance:  MetLife effective 1/1/19


MetLife Summary of Benefits effective 1/1/18 (for covered employees and dependents)

Certificate of Coverage  (for covered employees and dependents)

Tutorial For Finding A Dental Provider

Employee Dental Infomation (for covered employees and dependents)

Vision Discount Card (for covered employees and dependents)

Group Term Life Insurance/Voluntary Supplemental Life Insurance: MetLife effective 1/1/19

Certificate of Coverage: $30,000 (for covered employees)
Certificate of Coverage: $45,000 (for covered employees)
Cost sheet for Voluntary Supplemental Life Insurance
Certificate of Coverage: Voluntary Supplemental (for covered employees and covered dependents)
Beneficiary Form 


Group Long-Term Disability Insurance: MetLife effective 1/1/19

Certificate of Coverage: Less than $30,000 annual pay (for covered employees)
Certificate of Coverage: $30,000 or more annual pay (for covered employees)


CHI Health Employee Assistance Program (EAP): 402-398-5566

Summary of Benefits and Coverage

Nebraska Public Employees Retirement System (NPERS): 1-800-245-5712

Access to Full Website
Forms Link
County Handbook Link
Publications / Newsletter Link


Supplemental/Volunteer Benefits


Resolution 2019-045: Adoption of Plan Agreement 

 PROVISIONS: Collective Bargaining Agreements ~ Personnel Policy Bulletin



The below are ancillary voluntary benefits and providers.  There is no endorsement made by Sarpy County for one company versus another.
As the benefits are voluntary, employees are to contact the representative directly for information.  
Vendor Contact Person Contact information Types of Products
AFLAC Mark Friehe cell:  402-690-0594 Accident, Cancer, Criticall Illness, Supplemental Insurance, Etc.
Colonial Emmalee Westfall cell:  402-452-7614 Accident, Cancer, Criticall Illness, Supplemental Insurance, Etc.
Fort Dearborn Life   800-538-0379 Life Insurance
VOYA Financial (ING) Marshall Egermier cell:  402-445-2121 Deferred Compensation
Nationwide Matt Ring cell:  515-218-0303  Deferred Compensation
SilverLeaf Wealth Management (Mass Mutual) Peter Daiker Phone 402-934-7200  Fax 402-260-7073 Deferred Compensation, 529 Educational Savings Plan
Lincoln Financial Peter Daiker Phone 402-934-7200  Fax 402-260-7073 Deferred Compensation
Legal Shield Patrick Lillis cell:  210-627-1423  Pre-paid Legal Services and Identity Theft protection

Legal Documents/Notices

Notice of HIPAA Privacy Practices
Glossary of Health Coverage and Medical Terms
CHIP (Children's Health Insurance Program) Notice
Reliance Standard: Privacy Statement 
Continuation Coverage Rights Under COBRA

Mileage Rates

2019 Mileage Reimbursement Rates (Revised 1-2-19)

Exempt Management Benefit Summary
Fringe Benefit Summary: Exempt Management (effective 09/11/2018)

Chief Deputy Benefits (excludes Chief Deputy Sheriff)

Chief Deputy Benefits

Let us help you with any of your questions regarding Sarpy County Human Resources.

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