Employee Benefits Manual
This booklet is an outline of the procedures and forms that need to be completed when hiring new employees, when employees are terminating, or when an employee is making changes in the Diocese of Winona benefit programs. Enrollment/termination/changes for each benefit program are summarized separately and the corresponding forms to use are located with each section. Copies can and should be made for your use.
Please Note: Upon hiring new employees and upon employees terminating, it is necessary to notify the Employee Benefits Coordinator at the Diocese of Winona within 5 days of such event. Notification forms, (available via the links below), should be completed as soon as you aware of a new hire or a termination. It is not necessary for you to submit the enrollment forms or the termination forms at the same time that you are submitting the notification forms.
There are two Employee Benefit Forms Checklists at the back of this booklet that you can use to quickly reference what forms/books are needed for new employees, and for those employees terminating. If you have any questions, please do not hesitate to contact the Diocese of Winona Employee Benefits Coordinator at 507.454.4643, ext. 268.
Table of Contents
Employee Benefits Guide Overview
Notification of New Employee Hire or Increase in Hours
Notification of Employee Termination of Employment or Reduction in Hours
General Information
Contact Information
Employee Benefits Summary
Section A - Health and Dental Plan
- Health Summaries
- Dental Summary
- Enrollment Form for Group Coverage: Form A-1
- Group Coverage Change: Form A-2
Section B - Life, AD&D, and LTD Insurance
- Group Insurance Summary of Benefits - Life Insurance
- Group Insurance Summary of Benefits - Long-Term Disability Insurance
- Group Insurance Summary of Benefits - Accidental Death & Dismemberment Insurance
- Group Enrollment Form for Life and LTD: Form B-1
- Beneficiary Form for AD&D: Form B-2
- Election of Continuation of Group Life Insurance: Form B-3
- Beneficiary Continuation Form for Life Insurance: Form B-4
Section C — Pension Plan
- 403(b) Pension Information: Form C-1
- Salary Reduction Agreement: Form C-2
- DOW Termination Memo: Form C-6
Section D - Flexible Benefits Plan
- Flexible Benefit Plan Summary: Form D-1
- Flexible Benefits Election: Form D-2
- Claim Form/Request for Reimbursement: Form D-3 - pdf version - MS Word version
- Flexible Benefits Status Change: Form D-4
- Flexible Benefits Direct Deposit Authorization: Form D-5
New Hire Employee Benefits Checklist
Terminating Employee Benefits Checklist