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    Annual Required Notices
    File Size: 215K
    The Notices include: Consolidated Omnibus Budget Reconciliation Act (COBRA) Prescription Drug Coverage and Medicare Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP) Mental Health Parity Act (MHPA) Michelle's Law Newborns' and Mothers' Health Protection Act Patient Protection Act The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules Special Enrollment Rights Uniformed Services Employment and Reemployment Act of 1994 (USERRA) Women's Health and Cancer Rights Act of 1998 (WHCRA) Please review the attached Notices carefully and contact the Human Resources Department if you have any questions; otherwise please retain the Notices for future reference.
    Flexible Spending Account Summary Plan Description FY21
    File Size: 242K
    Information in this section relates to Health Flexible Spending Accounts, HFSA (Not Health Savings Account) Dependent Care Assistance Plan, DCAP
    Altus Dental Online
    File Size: 64K
    Just a few items available when using Altus Dental Online. View Usage Summary Print ID Cards Look up Claim Status Customer Services
    Summary of Employee Benefits FY23
    File Size: 781K
    Detailed summary of benefits available to eligible employees: 7/1/22 - 6/30/23
    Group Life Insurance for Faculty
    File Size: 249K
    Summary Plan Description
    Tuition Exchange Program (TEP) Policy 2022-2023
    File Size: 139K
    Tuition Exchange Program Policy
    Employee Benefit Enrollment/Change Form
    File Size: 190K
    This election form is to be completed when enrolling in or declining of group medical, dental, group term life insurance and/or voluntary term life insurance. To be completed when: Enrolling for benefits during open enrollment Changing existing benefits (restrictions and limitations may apply)
    Health Savings Account Form
    File Size: 119K
    The Health Equity Authorization Form needs to be completed by employees who: are enrolling in the HNE health plan for the first time OR are currently enrolled in the HNE health plan but have not been eligible to participate in the HSA (i.e., enrolled in a Health FSA or other medical plan) but have now met the eligibility requirements. IMPORTANT: Once you have completed the Statement of Health and/or Health Equity Authorization Form, you must submit the form(s) to kbradway@bfpassociates.com for processing. Please note: Your full election amount will not be approved until your Statement of Health is received and approved by Principal.
    Group Life Insurance for All Other Members
    File Size: 253K
    Summary Plan Description
    Tuition Exchange Program (TEP)- Preliminary Application form 2022-2023
    File Size: 122K
    Application for TEP tuition exchange program
    FY23 Initial Benefit Election Form
    File Size: 147K
    Enrolling for benefits for the first time (at time of hire)
    Importance of Pre-Treatment Estimates
    File Size: 22K
    What are pre-treatment estimates? Why are pre-treatment estimates important to me?
    Tuition Exchange Program (TEP)- Recertification Form for Academic Year 2022-2023
    File Size: 92K
    This form is required annually from students who currently receive a Tuition Exchange scholarship and wish to renew the scholarship for another year. Failure to submit this form will result in the termination of the scholarship.
    Group Long Term Disability for Faculty Members
    File Size: 278K
    Summary Plan Description
    CIC - TEP Student Application - Academic Year 2022-2023
    File Size: 418K
    Application for CIC tuition exchange program
    Group Long Term Disability for All Other Members
    File Size: 288K
    Summary Plan Description
    Altus Dental Certificate of Coverage
    File Size: 1205K
    This Certificate, along with the Benefits Summary describes the Plan. It describes the dental services covered by your Plan. It also explains how each is paid for and tells you how to use the Plan. If you have any questions, please contact Customer Service. Altus customer service number is: 1-877-223-0588
    Council of Independent Colleges CIC-TEP Information Academic Year 2022-2023
    File Size: 109K
    FAQ's regarding Council of Independent College tuition exchange program
    Group Voluntary Term Life BOOKLET - ALL MEMBERS
    File Size: 327K
    Summary Plan Description
    MA Pregnant Workers Fairness Act Notice
    File Size: 165K
    MA Pregnant Workers Fairness Act Notice
    Educational Assistance Program Application - Doctoral Program
    File Size: 168K
    Doctoral Programs Only Please see the Operations Manual for more information.
    Federal Family and Medical Leave Act Notice (FMLA)
    File Size: 501K
    Family and Medical Leave Notice
    Travel Assistance
    File Size: 322K
    As an employee covered by a group term life insurance policy from Principal Life Insurance Company, you are eligible for travel assistance services provided by AXA Assistance. You, your spouse and dependent children (whether traveling together or separately) have access to travel, medical, legal and financial assistance plus emergency medical evacuation benefits when traveling domestically or internationally 100 or more miles away from home for up to 120 consecutive
    Doctoral Tuition Educational Assistance Agreement
    File Size: 20K
    Doctoral Programs Only Please refer to the Operations Manual for more information.
    MA Paid Family and Medical Leave (MAPFML)
    File Size: 133K
    Additional Massachusetts Paid Family and Medical Leave Act information: Private plan summary information / FAQ's. What Is This Benefit? Am I Eligible For Benefits? Waiting Period Benefit Year Medical Leave Family Leave Combined Leave Weekly Benefit What is my cost? What is my employer’s cost for me? How do I apply for benefits?
    Group Voluntary Vision Coverage
    File Size: 1731K
    Vision coverage that gives you choice of provider options for exams, eyewear and other discounts
    Group Voluntary Vision Care Expense Insurance
    File Size: 532K
    Summary Plan Description
    Employee Assistance Program
    File Size: 653K
    From simple concerns like decreasing stress to complex issues such as losing a loved one, your Employee Assistance Program (EAP) provides recommendations and information to help you with life's everyday, and not so everyday, challenges. With short-term or long-term disability coverage from Principal Life Insurance Company, you and your immediate family have access to free, confidential services offered through your EAP.
    Disclosure Statement for Accelerated Benefit, Group Life Insurance
    File Size: 71K
    The state of Massachusetts now requires that employees be provided with an accelerated benefits disclosure form pertaining to their group term life and group voluntary term life insurance coverage.
    Discounts and Services
    File Size: 328K
    Use these discounts to help improve your life - financially, mentally and physically. These discounts are available through your group benefits from Principal. These discounts are not insurance.
    Principal Health Statement
    File Size: 250K
    The Statement of Health is to be completed by employees who are: Electing voluntary term life coverage for the first time and requesting over $20,000.00 in coverage OR Increasing their current level of voluntary term life coverage by more than $20,000.00
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