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 Customer Service: 800-753-8429
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
- Employee Summary and Plan Document
- Medical Employee Contribution Rates
- Gold Plan: Summary of Benefits and Coverages
- Blue Plan: Summary of Benefits and Coverages
- Working Spouse 2016 Form - Must be completed every year if electing spousal coverage
- SBC Uniform Glossary
Retiree Dependents
- Pre-65 Summary and Plan Document
- Pre-65 Open Enrollment Form and Rates
- Pre-65 Open Enrollment Letter
- Post-65 Summary and Plan Document
- Post-65 Open Enrollment Form and Rates
- Post-65 Open Enrollment Letter
- Working Spouse 2016 Form - Must be completed every year
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
- About the weight watchers reimbursement program through Apex Health Solutions
- Weight Watchers' reimbursement form
Working-spouse policy
Diabetes management
About the provider: Delta Dental
Delta Dental Customer Service: 800-524-0149
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 phone: 800-877-7195
Related:
Retail provider: CVS Caremark Options
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
Short-term disability claim form
How to report a disability claim
Additional programs available through Cigna
Disability Financial Worry and Recovery
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
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
Beneficiary election
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.
Forms:
Provider: IMPACT Solutions
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.