2013 Benefits Open Enrollment Forms and Information
| DOCUMENT | FILE |
|---|---|
|
Official Informational Memo to Faculty and Staff |
|
| 2013 Premium Rates | Download |
| Sample 2013 Enrollment Form | Download |
| Don’t know what your current benefit elections are? Click on Download for instructions. |
Download |
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|
2013 Enrollment Form (SU login/password required) |
Download |
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| Health Insurance (Blue Cross Blue Shield) | |
|
Summary of Benefits and Coverage (includes Prescription Drug Summary) |
Download |
| Glossary of Health Coverage and Medical Terms | Download |
| Prescription Drug Program (CVSCaremark) | |
| Prescription Drug List as of October 2012 | Download |
| Prescription Drug Exclusion List as of January 2013 | Download |
|
Prescription Plan Summary of Benefits: See Summary of Benefits and Coverage |
|
| Section 125 Flexible Benefits Plan - Cafeteria Plan (Boon-Chapman) | |
| All about our Flexible Benefits Plan | Download |
| Eligible and Non-Eligible Expenses for 2013 | Download |
| Boon-Chapman Direct Deposit Form | Download |
| Dental Insurance (Guardian Dental) | |
|
Dental Plan Description |
Download |
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| Vision Insurance (United Healthcare) | |
| Vision Plan Description | Download |
| Vision Provider List | Download |
|
Contact Lens Formulary List |
Download |
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