Optional Benefits

**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]

2021 - 2022 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:

Ameritas Enrollment Application:

• Dental/Vision Enroll/Change/Waive (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