Benefits Forms and Details for 2016

2016 Benefits Booklet

2016 Working Spouse Form - Must be completed every year if electing spousal medical coverage


About the Provider: Apex

Apex's website

Apex's Customer Service: 800-753-8429

Apex Claim Form

Provider Search

To determine if a physician or facility is in the network, you should search the Apex provider network

  • Select the Community Choice network
  • Enter the search criteria and click the continue button
  • Select a specific network radio button
  • Choose the Community Choice network and click the search button

Active Employees

Retiree Dependents

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

About the provider:  Delta Dental

Delta Dental's website

Delta Dental Customer Service: 800-524-0149

Dental Claim Form

The University pays 100 percent of the dental premium or there is no charge to employees for dental coverage in 2016.

About the provider: VSP - Vision Service Plan

VSP website

VSP phone: 800-877-7195

Vision claim form

Retail provider:  CVS Caremark Options 

CVS Caremark's website

Phone: 888-202-1654


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. 

From the FDA: Understanding generic medications

Plan Summary

To view the Summary of the Precription Drug plan,   click here.

Paper Claim Forms

To view and/or edit and print a Paper Claim Form,   click here.

Provider: Cigna

Cigna phone: 1-800-362-4462

Cigna's website

Short-term disability claim form

How to report a disability claim

Certificate book

Additional programs available through Cigna

Disability Financial Worry and Recovery

Healthy Rewards

Will Preparation

Identity Theft

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

Long-term disability claim form

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

 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: Chard Snyder

Phone: 800-982-7715

To get reimbursed for any remaining allowable 2016 Flexible Spending expenses, please submit the Reimbursement Claim form (listed below) with applicable receipts or statements to ChardSnyder. This must be received by ChardSnyder no later than May 31, 2017 for claims incurred prior to March 15, 2017.   


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