Benefits Forms and Details for 2017
Announcement of Changes for 2017
About the Provider: Anthem
Anthem's website: www.anthem.com
Anthem's Customer Service Phone Number: 1-844-653-7397
Provider Search
- To determine if a physician or facility is in the network, you should search the Anthem provider network
- Search as a Guest, click on “search by a selecting a plan/network”
- “What type of care are you searching for?” select Medical
- “What State do you want to search in?” select your state
- “Select a plan/network”, for members in Ohio select Blue Access PPO or out of state members select National PPO (BlueCard PPO) and Continue
- Select your search criteria
Information for Active Employees
- Summary of Benefits and Coverage
- Medical Plan Rates for 2017
- Gold Plan: Summary of Benefits and Coverages
- Blue Plan: Summary of Benefits and Coverages
- Working Spouse Form 2017 - Must be completed each year if electing spousal coverage
Information for Retiree Dependents
- Medical Plan Rates for 2017 for Retiree Dependents'
- Working Spouse Form 2017 - Must be completed each year if electing spousal coverage
- Pre-65 Open Enrollment Letter
- Pre-65 Open Enrollment Form and Rates
- Post-65 Open Enrollment Letter
- Post-65 Forms and Rates
- SBC Pre-65 Retiree Dependents Gold PPO
- SBC - Traditional Indemnity Plan Primary
- SBC - Traditional Indemnity Plan Secondary
About the provider: Delta Dental
Delta Dental Customer Service: 800-524-0149
Rates shown are monthly pre-tax full-time employee contributions. | |
Employee | $4.40 |
Employee + Spouse | $9.07 |
Employee + Child(ren) | $8.51 |
Employee + Spouse + Child(ren) | $13.12 |
Related:
About the provider: VSP - Vision Service Plan
VSP phone: 800-877-7195
Rates shown are monthly pre-tax full time employee contributions. |
|
Employee |
$9.84 |
Employee + 1 |
$19.68 |
Family |
$28.79 |
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 Prescription 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
Cigna policy description Amendment
Long-term disability claim form
About the coverage
University Provided |
60% Salary Replacement, $5,000 Monthly Benefit Maximum. The elimination period before benefits are paid is the later of any accumulated sick leave or 180 days. |
Supplemental Option |
70% Salary Replacement, $6,000 Monthly Benefit Maximum. The elimination period before benefits are paid is the later of any accumulated sick leave or 180 days. |
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 |
Life Insurance Continuation Options
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.
Verification of Medical Expenses
Flexible Spending Accounts are a smart way to pay for your out-of-pocket qualified healthcare and/or dependent care expenses. You can enjoy tax savings and a convenient debit card for your eligible expenses.
Flexible spending accounts allow employees to set aside money on a pre-tax basis to pay for eligible out-of-pocket medical and dependent care expenses, therefore reducing taxable income. The monies set aside for these accounts must be used for expenses not reimbursed by other coverage.
- The Health Care Spending Account allows you to be reimbursed for non-covered and medically necessary medical, dental or eye care expenses. Employees can contribute a maximum of $2,600 in into a health care flexible spending account. Participants will receive a debit card for easy FSA withdrawals for eligible items.
- The Dependent Care Spending Account allows you to be reimbursed for child and dependent care expenses (e.g., daycare) that are required for you or your spouse to work. Employees can contribute a maximum of $2,500 or $5,000 if married and filing a joint tax return.
- New for 2017: The FSA vendor will change to ChardSynder. The plan will continue to have a grace period for claim submissions. For all claims incurred prior to December 31, 2017, the claims must be submitted to ChardSnyder no later than March 31, 2018. In addition, FSA funds up to $500 may be carried over to the 2018 plan year. This change applies to Health FSAs only and does not apply to Dependent Care FSAs.
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.
Mailing address:
The University of Akron
Human Resources, Benefits Administration
Akron, Ohio 44325-0602
Building location:
Administrative Services Building
185 E. Mill St
Send us an e-mail.
Phone: 330-972-7090
Fax: 330-972-2336
Benefits Administration staff