|
Benefit
|
Insurer or Claims Administrator
|
Title of Benefit Booklet, Guide or Certificate
|
|
Medical OAP Plan
OAP Certificate Rider - July 2022
OAP Certificate Rider MA - July 2022
OAP Compliance Rider - July 2022
Summary of Benefits and Coverage "SBC"- July 1, 2023
|
Cigna Health and Life Insurance Company
Hartford, CT 06152 |
Open Access Plus Medical Benefits |
|
Medical OAP-IN Plan
OAP-IN Certificate Rider - July 1, 2022
OAP-IN Certificate Rider MA - July 1, 2022
OAP-IN Compliance Rider - July 1, 2022
Summary of Benefits and Coverage "SBC" - July 1, 2023
|
Cigna Health and Life Insurance Company
Hartford, CT 06152 |
Open Access Plus In Network Medical Benefits
|
|
Medical OAP HDHP Plan
OAP HDHP Certificate Rider - July 1, 2022
OAP HDHP Compliance Rider - July 1, 2022
Summary of Benefits and Coverage "SBC" - July 1, 2023
|
Cigna Health and Life Insurance Company
Hartford, CT 06152 |
Open Access Plus Medical Benefits,
Qualified High Deductive Health Plan
|
|
Dental PPO
Dental Certificate Rider - LDA
Dental Certificate Addendum
Certificate Rider - Jan. 1, 2019
Certificate Rider - April 1, 2019
Certificate Rider - July 1, 2020
|
Metropolitan Life Insurance Company
200 Park Avenue
New York, New York 10166
|
Your Employee Benefit Plan
Dental Expense Benefits
PPO Dental Plan
|
|
Dental Copay Plan
Dental Certificate Rider - LDA
Dental Certificate Addendum
Certificate Rider - Jan. 1, 2019
Certificate Rider - April 1, 2019
Certificate Rider - July 1, 2020
2020-2021 Dental Copay Rider - Copay Schedule
|
Metropolitan Life Insurance Company
200 Park Avenue
New York, New York 10166
|
Your Benefit Plan
Copay Dental Plan
|
|
Core Vision
|
Mid-Atlantic Vision Service Plan, Inc.
3333 Quality Drive
Rancho Cordova, CA 95670
|
Group Vision Care Policy
Certificate of Coverage
|
|
Vision Buy-up
|
Mid-Atlantic Vision Service Plan, Inc.
3333 Quality Drive
Rancho Cordova, CA 95670
|
Group Vision Care Policy
Certificate of Coverage
|
|
Core Life Insurance/AD&D Class 1 (Benefit Capped at $ 50,000
|
Symetra Life Insurance Company
777 108th Ave., NE, Suite 1200
Bellevue, WA 98004-5135
|
Group Term Life, AD&D, Supplemental Life, and Dependent Life Certificate of Insurance for Employees Capping the Benefit Amount to $ 50,000
|
| Core Life Insurance/AD&D, Supplemental Life, and Dependent Life Class 2 (Benefit Maximum $ 250,000) |
Symetra Life Insurance Company
777 108th Ave., NE., Suite 1200
Bellevue, WA 98004-5135
|
Group Term Life, AD&D, Supplemental Life, and Dependent Life Certificate of Insurance for Employees Electing the Maximum Benefit Amount of $ 250,000
|
|
Core and Buy-up Long-Term Disability Insurance Class 1 – Non 403b
|
Symetra Life Insurance Company
777 108th Ave., NE, Suite 1200
Bellevue, WA 98004-5135
|
Core and Buy-up LTD Insurance for Employees Not Receiving Loyola's 403b Contribution
|
|
Core and Buy-u Long-Term Disability Insurance Class 2 – 403b
|
Symetra Life Insurance Company
777 108th Ave., NE, Suite 1200
Bellevue, WA 98004-5135
|
Core and Buy-up LTD Insurance for Employees Receiving Loyola's 403b Contribution
|
|
Employee Assistance Program
|
KEPRO
777 East Park Drive
Harrisburg, PA 17111
|
Employee Assistance Program
|
|
Flexible Spending Accounts
HFSA SMM Effective July 1, 2020
|
Optum Financial
307 International Circle, Suite 200
Hunt Valley, MD 21030
|
Health Care and Dependent Care Flexible Benefits Plan Summary
Plan Description
|