For Five College Staff

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Summaries and Description 2018
Five Colleges Health and Dental Insurance Information 2018
Delta Dental PPO Subscriber's Certificate
HRA for the 2018 Health Plan

Harvard Pilgrim HMO Schedule of Benefits
Harvard Pilgrim Plan Information
Harvard Pilgrim Pediatric Dental HMO Information
Harvard Pilgrim PPO Schedule of Benefits
Harvard Pilgrim PPO Plan Information
Harvard Pilgrim PPO Pediatric Dental Benefit
Harvard Pilgrim 5 Tier Prescription Information
Harvard Pilgrim Doctor on Demand FAQ
Harvard Pilgrim Doctor on Demand Information
Harvard Pilgrim-Know iCare
Preventative Care Information
HIPAA Privacy Notice Updated for September 23 2013
Affordable Care Act - Health Insurance Marketplace Coverage Options

Health Reimbursement HMO (HRA) Welcome Letter
Health Reimbursement (HRA) Summary (SBC)
Health Reimbursement PPO (HRA) Welcome Letter
Health Reimbursement PPO (HrA) Summary (SBC)

Election Form Health FSA March 17 2016
Flexible Spending Summary (FSA) Plan Description (SPD) (Effective 1/1/2018)
Flexible Spending Summary (FSA) Amended & Restated Plan Document (Effective 1/1/2018)
FSA/HRA HIPAA Privacy Notice 09-23-2013

403B Retirement Summary Annual Report 2017 (SAR)
403B Retirement Plan Summary Plan Description 7/1/2014 (SPD)
Emeriti Summary Annual Report 2017 (SAR)
Emeriti Plan Highlights
Emeriti Summary Plan Description (SPD)
Summary of Material Modifications
Five Colleges Group Life Insurance Plan and Monthly Disability Plan


Agreement for Salary Reduction under Section 403(b)
HRA Claim Form
Employee Tuition Waiver Request Form
Affidavit of Domestic Partnership Form
Transportation Subsidy Enrollment Form


Employee Application for Medical Leave
Medical Leave Physician Statement
Medical Leave Return to Work Physician Statement
Statement in Support of Need for Domestic Violence Leave

FCI Performance Evaluations

The performance review process is an opportunity for employees and their supervisors to have an open dialogue about the employee’s performance for the past year and to set goals for the coming year. Working together, supervisors and employees can clarify expectations for one another to keep the mutual work environment productive and effective. Discussions should be ongoing throughout the year and is an opportunity to create a supportive partnership between manager and team.

The current Annual Performance Review Cycle:   April 1, 2018 to March 31, 2019

 Important dates for the Annual Performance Review cycle

 By September 30, 2018         Supervisors should meet with employees to establish goals

 By January 31, 2019              Supervisors should meet with employees to conduct mid-cycle check-in  

 By March 15, 2019                 Supervisors should request self-evaluations from all employees

 April 1- 15, 2019                    Supervisors should meet with employees and conduct performance reviews

 By April 19, 2019                   Supervisors should submit their written and signed reviews

Forms and Resources
  Fall:  Goal Setting
    Goal Setting Form
    Goal Setting Presentation

  Winter:  Mid Cycle Check-in
    Mid Cycle Form

  Spring:  Performance Evaluation
    Self-Evaluation Form
    Annual Performance Evaluation Form
    Stakeholder Form

  Orientation Period Evaluation Form
    Orientation Period Evaluation Form