Required Notices
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.
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Additional Massachusetts Paid Family and Medical Leave Act information:

Private plan summary information / FAQ's.

  1. What Is This Benefit?
  2. Am I Eligible For Benefits?
  3. Waiting Period
  4. Benefit Year
  5. Medical Leave
  6. Family Leave
  7. Combined Leave
  8. Weekly Benefit
  9. What is my cost?
  10. What is my employer’s cost for me?
  11. How do I apply for benefits?
(.pdf, 133K)
Summary of Employee Benefits

Detailed summary of benefits available to eligible employees: 7/1/21 - 6/30/22

(.pdf, 1298K)
Employee Benefit Enrollment/Change Form

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)
(.pdf, 552K)
Health Equity - Health Savings Account

The Health Equity Authorization Form needs to be completed by employees who:

  1. are enrolling in the HNE health plan for the first time OR
  2. 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 for processing.  Please note: Your full election amount will not be approved until your Statement of Health is received and approved by Principal.

(.pdf, 119K)
Dental Insurance Information - Altus Dental

Just a few items available when using Altus Dental Online.

  • View Usage Summary
  • Print ID Cards
  • Look up Claim Status
  • Customer Services
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  • What are pre-treatment estimates?
  • Why are pre-treatment estimates important to me?
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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
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Health Reimbursement Account (HRA)

This easy to use excel spreadsheet can assist you in keeping track of eligible medical expenses in order to:

  1. take advantage of the Health Reimbursement Account (HRA)
  2. ensure you do not have out-of-pocket expenses in excess of the deductible

Download this form to your desktop before entering your information.

(.xlsx, 31K)
Flexible Spending Account

Information in this section relates to

  • Health Flexible Spending Accounts, HFSA (Not Health Savings Account)
  • Dependent Care Assistance Plan, DCAP
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Benefits through Principal Financial

Available to eligible employees

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 
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Vision coverage that gives you choice of provider options for exams, eyewear and other discounts

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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.
(.pdf, 74K)
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.
(.pdf, 71K)

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.

(.pdf, 328K)

The Statement of Health is to be completed by employees who are:

  1. Electing voluntary term life coverage for the first time and requesting over $20,000.00 in coverage OR
  2. Increasing their current level of voluntary term life coverage by more than $20,000.00
(.pdf, 250K)
Educational Assistance & Tuition Exchange Programs
  • 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.
(.pdf, 92K)
  • Requests for tuition assistance should be submitted using this form. Please submit requests for the entire 2022 calendar year.
(.pdf, 230K)

Doctoral Programs Only

Please see the Operations Manual for more information.

(.pdf, 168K)

Doctoral Programs Only

Please refer to the Operations Manual for more information.

(.pdf, 20K)
  • Requests for tuition assistance should be submitted using this form. Please submit requests for the entire 2021 calendar year.
(.pdf, 231K)
Voluntary Benefits
  • AFLAC_Short Term Disability Voluntary Benefit
(.pdf, 840K)
  • AFLAC_Cancer Protection Assurance_Voluntary Benefit
(.pdf, 3847K)
  • AFLAC_Hospital Confinement_Voluntary Benefit
(.pdf, 3847K)
  • AFLAC_Accident Advantage_Voluntary Benefit
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