All applicable forms from this page - once complete - MUST be sent to Adrienne Cruse at the Central Office (unless otherwise noted).
Do NOT send these directly to the companies as they will not be able to process them. Please contact Adrienne Cruse at (270) 831-5000 if you have any questions.
Employees who are adding coverage because of a qualifying event and have previously waived coverage can complete a form.
Health Plan Questions: 1-844-402- KEHP
Pharmacy Questions: 1-866-601-6934
FSA (Flexible Spending Account) / HRA (Health Reimbursement Account): 1-877-430-5519
Humana Vitality 1-855-478-1623
Health Resources, Inc. (Open Enrollment - 1st week of November)
Health Resources Dental Application and Plan Information - This application for coverage can be used when you are a new hire or have a qualifying event. It also explains the dental coverage.
Children's Orthodontic Rider - This document explains orthodontic coverage for children under the age of 19.
Henderson County Vision Plan 23 Summary - This document explains the vision insurance coverage.
Henderson County Vision Employee Application - This application for coverage can be used when you are a new hire or have a qualifying event.
Henderson County Vision Provider Directory - Doctors that are part of the Vision insurance network of providers.
If an employee misses more than 3 days of work s/he must complete Application for Family Leave and return to the HR department. A Doctor must complete the Certification by Physician form and should return it to HR within 10 business days following the start of FMLA absence. Upon return to work, submit a return to work release to your supervisor. Your supervisor will complete the Return to Work form and send to the HR department.
SICK BANK -
Sick bank open enrollment must be completed by September 15. If you are interested in joining the sick bank please fill out the attached application. Please note there are different applications for classified and certified. If an employee no longer wants to participate in the sick bank, a cancellation must be submitted in writing to Adrienne Cruse.
SICK LEAVE DONATION -
Employees who have accumulated more than 15 days of sick leave may request to donate sick leave days to another employee authorized to receive the donation. Employees must complete the donation form and send to Jinger Carter in the Human Resources Department. Sick leave donation is for the current school year only and any unused days will be returned to the employee who donated it.
Change of Name or Address
When an employee changes their name or address, they must complete the "Employee Name / Address Change Form" and return it to Ashley Wright at the Center for Support Services (CSS) to ensure a timely update of personal information.
If an employee is injured while at work or performing work related duties, the internal incident report must be completed within 24 hours of the incident. The form must then be immediately returned to Adrienne Cruse.
If medical treatment outside of school premises is sought, complete the following:
Contact Adrienne Cruse for more information at 270-831-5000.