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Human Resources

Kami Perkins
Human Resources Director

90 North Main Street
Tooele, UT 84074

Phone: 435.843.2105
Fax: 435.843.2106

Provider Links

Dental

PEHP  801.366.7555 | 800.765.7347

•  Medical and Dental Enrollment Change Form

Disability

Short-Term Disability Master Policy Short-Term Disability Summary of Benefits

•  Short-Term Disability Insurance Claim Form

PEHP (Long-Term Disability)

Employee Assistance Program

Employee Brochure Blomquist Hale  800.926.9619

Flexible Spending Account

Benefit Management Services  801.532.3412 Flex Card Inquiry

•  Flexible Spending Account Enrollment Form

•  Flexible Spending Account Worksheet

•  Flexible Spending Account Reimbursement

How to Access Your Flex Account?

Health Insurance

Healthcare Plans (PEHP)

Summit Care  801.366.7555  |  800.765.7347

•  Health Insurance Waiver Form FY2021

•  Medical and Dental Enrollment Change Form

Healthy Utah Link

Pharmacy

•  Mail Order Pharmacy Form

Cost & Quality Tools

It's Your Money

Health Savings Account

•  Summary Plan Description (Effective July 1, 2013)

•  Health Savings Account Enrollment Form

•  U.M.B./Flex Check

Life Insurance

Mutual of Omaha Life Insurance

Certificates and Policies

Basic Term Life Insurance and AD&D

Certificate and Master Policy FTR Employees (Basic)

Certificate and Master Policy City Council (Basic)

Certificate and Master Policy EPC Retirees (Basic)

Certificate and Master Policy Retirees (Basic)

Voluntary Term Life and AD&D

Certificate and Master Policy Voluntary Term Life FTR Employees

Certificate and Master Policy Voluntary Term Life City Council

Certificate and Master Policy Voluntary Term Life EPC Retirees

Voluntary AD&D – FTR Employees

Optional Benefits

Colonial Life

Available Optional Benefits through Colonial Life

Retirement, 401K & IRA's

Utah State Retirement Office

John Hancock – Contract #67701

•  401K Change Form – John Hancock

•  401K Summary Plan Description for Tooele City Employees 401(k) Plan

•  Hardship Distribution Procedure

•  Loan and Distribution Fees

•  Addendum to Loan and Distribution Fees

•  Loan Procedure

•  Qualified Domestic Relations Order (QDRO) Procedure

Vision

Utah Local Governments Trust  800.748.4440

•  Vision Claim Form

•  Vision Enrollment Form

Worker's Compensation

Worker’s Compensation Fund of Utah

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