Employee Resources, Optional Benefits

Optional Benefits

Select an optional benefit below for resources:

Vision Benefits - Voluntary Vision
Flexible Spending Plans
McDonald's Stock Plan
Long Term Disability Plan
Voluntary Accidental Death & Dismemberment Insurance
Supplemental Life Insurance Plan

Vision Benefits - Voluntary Vision
www.davisvision.com
1-877-923-2847

Optional coverage to supplement the vision plan offered with your medical plan enrollment. Access the Davis Vision site listed above to find Davis Vision providers. Use the control code of 7205 for Simplot's vision providers.

Davis Vision Forms:


	Davis Vision Claim Form Complete this claim form to submit out of network claims to Davis Vision.

Flexible Spending Plans
www.principal.com
1-877-372-4730

You may enroll in a Health Reimbursement Account, Dependent Care Reimbursement and Auto Flex Plans.

Flexible Spending Account (FSA) Forms:


	FSA Claim Form Complete this form to receive reimbursement for Health Reimbursement or Dependent Care Reimbursement claims.

	FSA Claim Form Checklist Use this checklist when completing the FSA Claims form for reimbursement.

	FSA Direct Deposit Complete this form to have your claims automatically deposited into your bank account.

McDonald's Stock Plan
www.computershare.com/mcdonalds
1-800-621-7825

You may purchase McDonald's Stock without brokerage fees.

McDonald's Stock Forms:


	McDonald's Stock Enrollment Form Complete this form to enroll and purchase McDonald's stock.

	McDonald's Stock Payroll Authorization Form Complete this form to authorize payroll deductions for your McDonald's stock enrollment.

Long Term Disability Plan
www.standard.com
1-800-368-1135

The company provides a long term disability plan for salaried employees and some hourly employees at specific locations. You may purchase additional long term disability coverage.

Voluntary Accidental Death & Dismemberment Insurance
www.regencelife.com
1-800-286-1129

You may purchase Voluntary Accidental Death & Dismemberment Insurance coverage.

Voluntary Life Insurance Plan - Group Universal Life
www.principal.com
1-800-255-6614

You can purchase additional Life Insurance coverage.

Related Forms:


	GUL Beneficiary Form Complete this form to designate a beneficiary for your Group Universal Life Insurance Plan.

	GUL Enrollment Form Complete this form to enroll in the Group Universal Supplemental Life Insurance Plan.

	GUL Payroll Deduction Authorization Form Complete this form to authorize deductions to be taken from your paycheck.

	GUL Personal Worksheet Tool to assist you in calculating your coverage amount.

	GUL Statement of Health To be completed only for employees requesting coverage in excess of the guaranteed coverage, or enrolling outside their enrollment period.

	GUL Rate Table A monthly rate table for the Group Universal Life benefit.

	GUL Adjustment Application An application to adjust your benefit selection.

EMPLOYEE RESOURCES HOME

Select a topic below to view benefit information and/or associated forms:

Benefit Topics:
Benefit Enrollment
Health & Welfare Benefits
Medical Providers by State
Optional Benefits
Retirement Benefits

Note: Some sites require a user name and password.

Disclaimer: Benefits vary by location, employment status, union status, hours, etc.. Please contact the Employee Service Center if you have questions regarding your benefit eligible plans.