Concerning Family Medical Leave Act (FMLA) Diane Thomas, Personnel/Payroll Manager459-1377 or dthomas@fnsb.usORRenee Dick, Personnel Assistant459-1201 or rdick@fnsb.us For existing and old Workers’ Compensation Claim Questions Workers' Compensation AdjusterPO Box 71267Fairbanks, AK 99707(907) 459-1129 ORAlaska Workers' Compensation Board Fairbanks Office675 7th Avenue, Suite KFairbanks, AK 99701(907) 451-2889 For Health Benefit Questions General Coverage Questions Welfare & Pension Administration Service, Inc (WPAS) www.fnsbandsd.comMedical/Dental/Hearing 1-800-331-6158 (Option 8) Vision www.vsp.com 800-877-7195 Prescription Drug PlanCaremark CVS www.caremark.com 1-866-818-6911 Caremark P.O. Box 94467 Palatine, IL 60094-4467 Flexible Spending AccountNavia Benefit Solutions1-800-669-3539 www.naviabenefits.com For Human Resources Policy Questions Sallie Stuvek, Human Resources Director459-1207 or sstuvek@fnsb.usOR Diane Thomas, Personnel/Payroll Manager459-1377 or dthomas@fnsb.us For Life Changes Birth, Adoption, or Obtain Legal Guardianship of a ChildThe following forms need to be completed and turned into Human Resources:• Health Insurance Form (with copy of child’s birth certificate)• Life Insurance Change of Beneficiary Form• PERS Beneficiary Form• W-4The Human Resources Department will notify PERS, Welfare and Pension Administrators, and your Union if you are a member.DivorceThe following forms need to be completed and turned into Human Resources:• Change of Address / Phone or Other Personal Information Form• Health Insurance Payroll Deduction Form - FNSB• Health Insurance Payroll Deduction Form - Pages• Health Insurance Form (with members of the family to be covered after divorce)• Life Insurance Change of Beneficiary Form• PERS Beneficiary Form (with copy of Divorce Decree/Official Court Affidavits to include QDRO, and Child Support agreement)• Social Security Card (with new name, if applicable) must be submitted to HR before name change will take place• W-4The Human Resources Department will notify PERS, Welfare and Pension Administrators, and your Union if a member.MarriageThe following forms need to be completed and turned into Human Resources:• Change of Address / Phone or Other Personal Information Form• Health Insurance Payroll Deduction Form - FNSB• Health Insurance Payroll Deduction Form - Pages• Health Insurance Form (with members of the family to be covered after divorce)• Life Insurance Change of Beneficiary Form• PERS Beneficiary Form (with copy of Divorce Decree/Official Court Affidavits to include QDRO, and Child Support agreement)• Social Security Card (with new name, if applicable)• W-4Death in your immediate Family or of a BeneficiaryThe following forms need to be completed and turned into Human Resources:• Health Insurance Payroll Deduction Form - FNSB (if death was a spouse or dependant child and you are not employed as a “Page”)• Health Insurance Payroll Deduction Form - Pages (if death was a spouse or dependant child and you ARE employed as a “Page”)• Life Insurance Change of Beneficiary Form (if death was a spouse or beneficiary)• Life Insurance Claim Form (if your spouse was enrolled in the supplemental life insurance program)• PERS Enrollment Form (if death was a spouse)• PERS Beneficiary Form (if death was a spouse or beneficiary)• W-4 For Payroll Questions Darrah Fitzpatrick, Personnel Payroll Technician III459-1372 or dfitzpatrick@fnsb.us ORLeva Leverenz, Personnel Payroll Technician III459-1373 or lleverenz@fnsb.us ORDiane Thomas, Personnel/Payroll Manager459-1377 or dthomas@fnsb.us For PERS Retirement Questions Public Employees Retirement System (PERS)PO Box 110203 Juneau, AK 99811-0203 1-800-821-2251 Natasha Golovatiuk, Regional Counselor 1-800-821-2251 (907) 465-4495 FAX: (907) 465-3086 Natasha,Golovatiuk@alaska.gov PERS Changes – such as address, phone number, marital status, or beneficiaries:Renee Dick, Personnel Assistant 459-1201 or rdick@fnsb.us For Questions on How to File a Workers' Compensation Claim Workers' Compensation AdjusterPO Box 71267Fairbanks, AK 99707(907) 459-1129 For Recruitment Status Questions Nikki Garcia, Administrative Assistant IV 459-1202 or ngarcia@fnsb.us ORRenee Dick, Personnel Assistant 459-1201 or rdick@fnsb.us For Sick Leave Bank Questions Diane Thomas, Personnel/Payroll Manager 459-1377 or dthomas@fnsb.us For Union Question See the Union and Collective Bargaining Information Pagehttp://www.fnsb.us/hr/Pages/Union-Contacts.aspx Regarding Health Plan Cards and/or Rx Drug Cards Carrie Carnes, Claims Administrator459-1393 or ccarnes@fnsb.usORKathryn Norvilla, Risk Technician459-1371 or knorvilla@fnsb.us