{"id":903,"date":"2021-03-08T21:44:47","date_gmt":"2021-03-08T21:44:47","guid":{"rendered":"http:\/\/schooldistrictbenefits.com\/redclay\/n\/?page_id=903"},"modified":"2026-04-29T19:13:07","modified_gmt":"2026-04-29T19:13:07","slug":"forms-2","status":"publish","type":"page","link":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/forms-2\/","title":{"rendered":"Forms and Rates"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;1_3,1_3,1_3&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;enrollment&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h3>Enrollment<\/h3>\n<ul class=\"left-list\">\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2025\/07\/Benefit-Enrollment-Form-FT-25-26.pdf\" target=\"_blank\" rel=\"noopener\">Benefit Enrollment Form<\/a><\/li>\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2025\/07\/Benefit-Enrollment-Form-Qualifying-Event-FY26.pdf\" target=\"_blank\" rel=\"noopener\">Qualifying Event Benefit Enrollment Form<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text admin_label=&#8221;dental&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h3><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/dental\/\">Dental<\/a><\/h3>\n<ul class=\"left-list\">\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2022\/08\/Cigna-Guide.pdf\" target=\"_blank\" rel=\"noopener\">Cigna Guide<\/a><\/li>\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2022\/08\/Cigna-Dental-Benefit-Summary-New.pdf\" target=\"_blank\" rel=\"noopener\">Cigna Dental Benefit Summary<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text admin_label=&#8221;Flexible&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/flexible-spending-plan\/\">Flexible Spending Accounts<\/a><\/h3>\n<ul class=\"left-list\">\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2025\/07\/FSA-Enrollment-Form-FY26.pdf\" target=\"_blank\" rel=\"noopener\">ASI Enrollment Form FY26<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/fsa\/documents\/claim-form.pdf\" target=\"_blank\" rel=\"noopener\">Flexible Spending Account Claim Form<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/fsa\/documents\/fsa-enrollment-guide.pdf?ver=0406\" target=\"_blank\" rel=\"noopener\">FSA Open Enrollment Guide<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/fsa\/documents\/debit-card-application.pdf?ver=0310\">ASI Debit Card Application<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/fsa\/documents\/direct-deposit-form.pdf\" target=\"_blank\" rel=\"noopener\">\u201cGo Green\u201d Notification &amp; Payment Authorization<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/fsa\/documents\/leave-of-absence-form.pdf?ver=0211\">ASI Leave of Absence Form<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/fsa\/plan-booklet.shtml\">ASI Plan Booklet<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;med&#8221; _builder_version=&#8221;4.20.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/medical-prescription-drugs\/\">Medical\/Prescription Drugs<\/a><\/h3>\n<ul class=\"left-list\">\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/cob\/enroll-drop\/education-spouse.shtml\" target=\"_blank\" rel=\"noopener\">Spousal Coordination of Benefits Form<\/a><\/li>\n<li><a href=\"https:\/\/dhr.delaware.gov\/benefits\/cvs\/documents\/claim-form.pdf\" target=\"_blank\" rel=\"noopener\">CVS Reimbursement Form<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text admin_label=&#8221;Life and AD&#038;D&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3>Life and AD&amp;D Insurance<\/h3>\n<ul class=\"left-list\">\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2021\/02\/Prudential-Flyer.pdf\" target=\"_blank\" rel=\"noopener\">Summary of Benefits<\/a><\/li>\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2022\/08\/Prudential-Life-Designation-of-Beneficiary-Form.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Designation of Beneficiary<\/a><\/li>\n<\/ul>\n<p>[\/et_pb_text][et_pb_text admin_label=&#8221;Benefit Rates and Deduction Schedule&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h3><em>Benefit Rates and Deduction Schedule<\/em><\/h3>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1HHvxfPB8qyJYbKLHqmdPboL2gr_lwV9z\/view?usp=sharing\" target=\"_blank\" rel=\"noopener\">25-26 Benefit Rates<\/a><\/li>\n<li><a href=\"https:\/\/acrobat.adobe.com\/id\/urn:aaid:sc:US:8a4bc712-7e99-442a-a54b-e7bb5ba952b0?viewer%21megaVerb=group-discover\">26-27 Benefit Rates <\/a><\/li>\n<li><a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-content\/uploads\/2025\/04\/Health-Comparison-Chart-FY26.pdf\" target=\"_blank\" rel=\"noopener\">Health Comparison Chart FY26<\/a><\/li>\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/16loVWA_hFoCTeGeU29mq1I6O6Eqg1Vso\/view\">Health Comparison Chart FY27<\/a><\/li>\n<li><a href=\"https:\/\/drive.google.com\/file\/d\/1PS4TC64C48nJAfdrjQPQzVgsY_QaN3I_\/view?usp=sharing\" target=\"_blank\" rel=\"noopener\">2025 Benefit Deductions Schedule<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_3&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;general info&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;||20px|17px|false|false&#8221; hover_enabled=&#8221;0&#8243; border_color_all=&#8221;#cccccc&#8221; border_width_left=&#8221;2px&#8221; border_color_left=&#8221;rgba(224,43,32,0.8)&#8221; global_module=&#8221;763&#8243; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<h3>Questions?<\/h3>\n<p><b><br \/>For questions or more information on anything not listed, please <a href=\"http:\/\/schooldistrictbenefits.com\/redclay\/n\/contact\/\">contact the Red Clay Benefits Office<\/a> or call (302) 552-3738 or email BenefitsOffice@redclay.k12.de.us.<\/b><\/p>\n<p>&nbsp;<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enrollment Benefit Enrollment Form Qualifying Event Benefit Enrollment Form Dental Cigna Guide Cigna Dental Benefit Summary Flexible Spending Accounts ASI Enrollment Form FY26 Flexible Spending Account Claim Form FSA Open Enrollment Guide ASI Debit Card Application \u201cGo Green\u201d Notification &amp; Payment Authorization ASI Leave of Absence Form ASI Plan Booklet Medical\/Prescription Drugs Spousal Coordination of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-903","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/pages\/903","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/comments?post=903"}],"version-history":[{"count":60,"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/pages\/903\/revisions"}],"predecessor-version":[{"id":2018,"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/pages\/903\/revisions\/2018"}],"wp:attachment":[{"href":"https:\/\/schooldistrictbenefits.com\/redclay\/n\/wp-json\/wp\/v2\/media?parent=903"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}