Human Resources

Kami Perkins
Human Resources Director

90 North Main Street
Tooele, UT 84074

Phone: 435.843.2105
Fax: 435.843.2106

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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 FY2020

• Medical and Dental Enrollment Change Form

Healthy Utah Link

PEHP Basix Wellness Works

Pharmacy

• Mail Order Pharmacy Form

Health Savings Account

• Health Savings Account Enrollment Form

Summary Plan Description (Effective July 1, 2013)

Life Insurance

Mutual of Omaha Life Insurance

• Mutual of Omaha Change Form

• Mutual of Omaha Designation of Beneficiary

• Mutual of Omaha Enrollment Form

Optional Benefits

Retirement, 401K & IRA's

Utah State Retirement Office

John Hancock – Contract #67701

• 401K Change Form – John Hancock

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

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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