Benefits forms and enrollment information for 2014

Benefits orientation

Benefits overview and orientation


Plan details

About the provider: Apex

Apex's site

Apex Customer Service: 800-753-8429

Apex claim form


For active employees

Medical and Prescription Employee Contribution Rates

Member handbook

Gold Plan 

Blue Plan 


For retiree dependents


Preventive care list

  • See the list. The University follows the Affordable Care Act’s “U.S. Preventive Services Task Force” guideline for 100 percent University-paid preventive care.

Apex prior authorization list

  • Certain services require pre-authorization by Apex. If the patient is using an in-network provider, it is the physician's responsibility to obtain a pre-authorization. If the patient is using an out-of-network provider, it is the patent's responsibility to obtain prior authorization. Prior authorization can be waived in emergency situations. If the University's medical insurance is being used as secondary coverage, prior authorization is not required.

COBRA coverage


Weight Watchers


Working-spouse policy


Diabetes management


Definitions

About the provider: Delta Dental

Delta Dental's site

Delta Dental Customer Service: 800-524-0149

Dental claim form

Related:​

About the provider: VSP - Vision Service Plan

VSP site

VSP phone: 800-877-7195

Vision claim form

Related:

Retail provider:  CVS Caremark Options 

CVS Caremark's site

Phone: 888-202-1654

Prescription benefits summary


Prescription Gold Card

Prescription Blue Card


Participating pharmacies

Beyond CVS, these pharmacies will accept your prescription ID card.


Mandatory generic policy

If the member or the physician wishes to use a brand name drug when the U.S. Food and Drug Administration has determined a therapeutically equivalent (“AA” or “AB” rated) generic is available, the member will pay the difference in the brand name and generic medication price, plus the generic co-payment. Members may still elect to use brand name medications if they choose, but they will be required to pay the difference in the brand name and generic medication price, plus the generic co-payment. 

Understanding generic medications

Provider: Cigna

Cigna phone: 1-800-362-4462

Cigna's site

ST disability claim form

How to report a disability claim

Certificate book

Will preparation program

About the coverage

Salary replacement 60%, $1,400 maximum weekly benefit. Must exhaust sick leave.
Waiting period 14 Days for Injury, 28 Days for Illness, including pregnancy
Employee cost Varies by age and salary, 100 percent employee funded
Limitation Plan is subject to a 12/12 pre-existing condition limitation.

Provider: Cigna

Cigna phone: 1-800-362-4462

Cigna policy description

Certificate

 

LT disability claim form

Short-term disability claim/intake form

Will preparation program

About the coverage

University Provided 60% Salary Replacement, $5,000 Monthly Benefit Maximum. Benefit Pays after six-month waiting period from last day worked. Must exhaust sick leave.
Supplemental Option 70% Salary Replacement, $6,000 Monthly Benefit Maximum. Benefit pays after six-month waiting period from last day worked. Must exhaust sick leave.
Employee Cost 60% Option: $0, 100% University Funded. 70% Option: Varies. Employee pays difference between 60% and 70% option. Cost varies by salary.

Provider: Minnesota Life

Minnesota Life policy description

Group Term Life Policy Amendment 1

 A.  Class 1 Details

 B.  Class 2 Details

 C.  Class 3 Details

 D.  Class 4 Details

 E.  Class 5 Details


Beneficiary election 

Beneficiary election form

​Return the form to Human Resources Benefits Administration, +0602


About the coverage

University Provided Two times your annual salary. Maximum $100,000.
Accelerated Benefit Available if diagnosed as terminally ill (12 months or less life expectancy)  Contact Minnesota Life for details.
Supplemental Options Employees may purchase 1 to 5 times their annual salary up to $500,000 without an "evidence of insurabilty" medical exam. Costs varies by age and salary
Vendor Minnesota Life

Please use these forms if you sustain a work-related injury. Completion of these forms does not assure the allowance of the claim in accordance with the Ohio Bureau of Workers’ Compensation.

Provider: NWGS (Northwest Group Services)

NWGS’s site

Phone: 888-808-3008

Check their account transactions and balances by registering. When registering, enter your Social Security Number in the employee ID field. When completing the employer ID field, you should select "card number" from the drop down menu and enter your debit card number.

Forms:

PDF icon Direct Deposit Form

PDF icon Reimbursement Claim Form

Provider: IMPACT Solutions

Impact Solutions’ site

IMPACT Solutions is the administrator of the University’s confidential employee-assistance program.

The IMPACT Employee Assistance (EAP) & Work/Life Program offers access to confidential professional support 24 hours a day, 365 days a year. The IMPACT program includes access to unlimited phone consultation, six complimentary face-to-face counseling sessions per person per occurrence, plus an expansive collection of resources.

The IMPACT Employee Assistance (EAP) & Work/Life Program is available 24 hours a day, 7 days a week by calling 800-227-6007.

For additional information, log on to Impact Solutions’ site for access to articles, resources and interactive features. The member logon is UAkron.

PDF IMPACT Employee Assistance and Work/Life Program

PDF IMPACT on the Web's Quit Center for tobacco addition

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