Blue Cross and Blue Shield of Mississippi

P. O. Box 23734

Jackson, MS 39225-4208


      Enrollment Form

      Base and Select Coverage

      Summary of Base Coverage

      Summary of Select Coverage


      Yearly Wellness Challenge


Humana Dental and Vision

1100 Employers Blvd

Green Bay, WI 54344


Mississippi Deferred Compensation Plan & Trust

Systematized Benefits Administrators, Inc. (SBA)

P.O. Box 105

Jackson, MS 39205-0105


601.362.4021 fax

Unum Life Insurance

4619 Main Street, Suite A

Moss Point, MS 39563

800.456.8647 / 228.475.8687

228.475.8156 fax

American Fidelity (Cafeteria Plan)

Bart Carter (

101 Lake Court Suite A

Jackson, MS 39232


601.932.1076 fax

Disability Forms

Flex & Section 125

PERS (Public Employee Retirement System)

429 Mississippi Street

Jackson, MS 39201

800.444.7377 / 601.359.3589

Enrollment Form

Beneficiary Form

Non-Covered Form (Bus Drivers Only)

Retiree Re-enrollment Form

Leave Requests

Consolidated Omnibus Budget Reconciliation Act (COBRA)

COBRA gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan.

COBRA generally requires that group health plans sponsored by employers with 20 or more employees in the prior year offer employees and their families the opportunity for a temporary extension of health coverage (called continuation coverage) in certain instances where coverage under the plan would otherwise end.

COBRA outlines how employees and family members may elect continuation coverage. It also requires employers and plans to provide notice.