Standard Life Insurance Beneficiary Form

Misc Payments Beneficiary Designation

Pension Beneficiary Designation Form

2024 Active ATU Contribution Rates

2024 Active IBEW Contribution Rates

2024 Active Salaried Contribution Rates

2024 ATU Retiree Contributions

2024 IBEW Retiree Contributions

2024 Salaried Retiree Contributions

The Work Number/Talx Brochure

Lincoln Financial 401(k) Enrollment Guide

Lincoln Financial 401(k) Rollover Request

Federal Withholding Form W-4 (Employee)

Illinois Withholding Form W-4 (Employee)

Missouri Withholding Form W-4 (Employee)

Union Medical-Dental-Vision Enrollment Form

Salaried Medical-Dental-Vision Enrollment Form

Retiree Medical-Dental-Vision Enrollment Form

Paylocity FSA Enrollment Brochure & Claim Form

Beneflex SECTION 213 FSA Expenses

Delta Dental Benefits 24

Delta Dental Benefits 24 Login

Delta Dental Claim Form

Express Scripts Claim Form – Employees & Retirees < Age 65

Express Scripts Claim Form – Retirees > Age 65

Eye Med Brochure

EyeMed Out of Network Claim Form

CIGNA Claim Form

Medicare Certificate of Creditable Coverage

Release of Information

Full-Time Call-A-Ride Optional Life Application

Full-Time Salaried Optional Life Application

IBEW Optional Life Application

HIPAA Disclosure Release Form

HIPAA Notification Communication

Notice of Privacy Practices (2017)

Breach Notification Log

Breach Policy – Protected Health Information

Employee Change Form

Call Milliman at 1-877-265-7703 for a Pension Estimate (estimate only based on potential retirement date) or a Pension Packet (retirement documents at least 30 days prior to declared retirement date)

Submit completed forms by mail to:
Milliman Inc.
1301 Fifth Avenue, Suite 3800 
Seattle, WA 98101

Life Events:  If you have an IRS Qualifying Life Event, such as Marriage, Birth or Adoption of a Child, Divorce, Legal Separation, Lose or Gain Access to other Medical, Dental, &/or Vision coverage, you have 31 days from the date of the event to make changes to your current coverage.

If it is past 31 days from the event, you will have to make your changes during Open Enrollment, in October, or wait until you have another Qualifying Life Event.

Under each heading is an Informational Sheet that explains what you will need to do to make changes to your benefits, including what form(s) you will need to complete and documentation you will need to provide to the Benefits Department.

Qualifying Life Events include:

1. Change in dependents: birth or adoption of a child, child no longer eligible, child(ren) can get other coverage, child(ren) lost coverage.
2. Change in marital status: marriage, divorce, or legal separation.
3. Death of employee, spouse, or dependent.
4. Change in employment status of employee or spouse: gain or lose access to coverage.

You have 31 days from the date of the event to make changes to your coverage.

Information Sheet

Hourly Enrollment Form

Salaried Enrollment Form

Life Insurance Beneficiary Form

Misc Payment Beneficiary Form

Pension Beneficiary Form

For information about FMLA, contact Absence Management at 314-982-1597.

Information Sheet

Hourly Enrollment Form

Salaried Enrollment Form

Life Insurance Beneficiary Form

Misc Payments Beneficiary Form

Pension Beneficiary Form 

Information Sheet

Hourly Enrollment Form

Salaried Enrollment Form

Retiree Enrollment Form

Life Insurance Beneficiary Form

Misc Payments Beneficiary Form

Pension Beneficiary Form

Bi-State Development (BSD)/Metro provides contribution deferrals for benefit payments when an employee is not actively at work and is not receiving a paycheck. The contributions due for health benefits and/or for pension benefits are not being collected through payroll deduction. Therefore, these employee contributions are deferred until such time the contribution arrears are collected.

Health Benefits: BSD provides contribution deferrals for health benefits (medical, dental, &/or vision) for up to 90 days. Employees who receive this deferral of required contributions consent to reimburse BSD for the advance through direct payment by check or money order or deductions from their wages when they return to work. Should an employee return to work prior to the 90-day contribution deferral limit, double deductions per applicable benefit will occur through payroll deduction each pay period representing a current benefit contribution and one arrears payment until all deferred contributions are collected.

Employees will receive a statement at approximately 60 days that shows accumulated arrears and how to make a direct payment to BSD to avoid potential health benefit cancelation, should arrears accumulate beyond 90 days. If health coverage is canceled as a result of deferred contributions accumulating beyond 90 days, the employee will not be permitted to re-enroll in those benefits until the next Open Enrollment following full reimbursement of the contributions that were advanced by BSD.

Pension Benefits: BSD also provides contribution deferrals for employees with pension benefits. These arrears are collected through double deductions upon return to work by the employee, with repayment of one extra pension contribution per pay date in addition to the regular current contribution for that pay cycle. If the employee does not return to work, the pension arrears contributions may be deducted from the pension at the time of retirement until repayment is completed.

To check your arrears balance:

For a current arrears balance, log into Oracle, where you view your pay slip, click on Metro Employee Self-Service, then near the bottom click on Arrears.

How to make a payment:

Send a check or money order, made payable to Bi-State Development to:

Bi-State Development

PO Box 775262

Chicago, IL  60677-5262

Include your Badge # on the check or money order, along with a note as to how to apply your payment (example: $500 = $470 for medical, $20 for dental, $10 for vision).

Post-Employment FAQ