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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 Policy

Short-Term Disability Summary of Benefits

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

Full Time Regular (FTR) Employees Benefit Summary and Policy (Basic Life)

City Council Benefit Summary and Policy (Basic Life)

Earned Premium Credit (EPC) Retirees Benefit Summary and Policy (Basic Life)

Retirees Benefit Summary and Policy (Basic Life)

Voluntary Term Life and AD&D

Full Time Regular (FTR) Benefit Summary and Policy (Voluntary Term Life)

City Council Regular Benefit Summary and Policy (Voluntary Term Life)

Earned Premium Credit (EPC) Retirees Benefit Summary and Policy (Voluntary Term Life)

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 Employee Information Change Request – 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

•  Qualified Domestic Relations Order (QDRO) Procedure

•  Savers Tax Credit Information

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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