Benefits
Enroll, Change, View Benefits/Qualifying Life Event
- 2021 Benefit Premiums
- 2021 Benefit Premiums - Resident & House Staff
- 2021 COBRA Premiums
- 2022 Benefit Premiums
- 2022 Benefit Premiums - Resident & House Staff
- 2022 COBRA Premiums
- Dependent Eligibility Matrix
- Domestic Partner Affidavit
- Termination of Domestic Partnership
- Common Law Affidavit
Benefit Overviews
- 2021 Employee Benefits Overview
- 2021 Physician Benefits Overview
- 2021 Resident-House Staff Benefits Overview
- 2021 Traveler Benefits Overview
- 2021 Urgent Care-Quick Care Employee Benefits Overview
- 2021 Urgent Care-Quick Care APP Benefits Overview
- 2021 Urgent Care-Quick Care Physician Benefits Overview
- 2022 Employee Benefits Overview
- 2022 Physician Benefits Overview
- 2022 Resident-House Staff Benefits Overview
- 2022 Traveler Benefits Overview
- 2022 Urgent Care-Quick Care Employee Benefits Overview
- 2022 Urgent Care-Quick Care APP Benefits Overview
- 2022 Urgent Care-Quick Care Physician Benefits Overview
Medical Plan Information
- Premier Plan Schedule of Benefits
- Value Plan Schedule of Benefits
- Choice Plus Plan Schedule of Benefits
- Choice Plus Plan Amendment
- Value & Premier Summary Plan Description (SPD) w/ Pharmacy Book
- Choice Plus Summary Plan Description (SPD) w/ Pharmacy Book
- Understanding your Explanation of Benefits (EOB)
- 2021 Choice Plus Summary of Benefits & Coverage
- 2021 Premier Plan Summary of Benefits & Coverage
- 2021 Value Plan Summary of Benefits & Coverage
- 2022 Choice Plus Summary of Benefits & Coverage
- 2022 Premier Plan Summary of Benefits & Coverage
- 2022 Value Plan Summary of Benefits & Coverage
Dental Plan Information
- Dental Plan Comparison
- Basic (DHMO) Plan Document
- Premier Plan Document
- Value Plan Document
- Cigna Dental Premier
- Cigna Dental Premier - Ortho Passive
- Cigna Dental Value
- Cigna Dental DHMO Charge Schedule
- Annual Compliance Rider CDC
- Annual Compliance Rider DPPO
- Extra Territorial Rider CDC
- Policy Amendment DHMO
- 2022 Basic (DHMO) Summary Plan Description
- 2022 Extra Territorial Rider (DHMO)
- 2022 CIGNA Dental Premier – Ortho Passive SPD
- 2022 DHMO Policy Amendment
- 2022 Premier Plan SPD
- 2022 Value Plan SPD
Vision Plan Information
Pharmacy
- 2021 Aetna Standard Plan
- 2021 Aetna Standard Preventive Medicine List
- 2021 ASP Exclusions Drug List
- 2021 Banner Employee Plan BFP $0 List
- 2021 Drug Exclusions Plan Design Drug List
- 2021 Maintenance Medical Drug List
- 2021 Safe Harbor Additions to Aetna List
- 2021 Specialty Drug List
- How it Works: Specialty Copay Optimization Program
- Specialty Copay Optimization Drug List
Spending Accounts
Additional Resources
- Tobacco Cessation Program
- FAQ Benefit Plan ID Card
- Adoption Assistance Plan
- Adoption Assistance Plan Overview
Life and AD&D
Disability Benefits
- Long Term Disability Plan Certificate - Employees
- Long Term Disability Plan Certificate - Physicians
- Long Term Disability Plan Certificate - Residents and House Staff
- Long Term Disability Process
- Short Term and Long Term Disability Frequently Asked Questions (FAQ)
- Short Term Disability Process
- Short Term Disability Summary Plan Description
- Short Term Disability Return to Work Authorization
Supplemental Benefit Summary
- Accident Plan (Eng)
- Accident Plan (Spa)
- Critical Illness
- Critical Illness Certificate Amendment
- Hospital Indemnity (Eng)
- Hospital Indemnity (Spa)
MyWell-Being
Compliance
- 2020 Summary Annual Report
- Children's Health Insurance Program Notice
- General COBRA Notice
- HIPPA Privacy Notice
- HIPPA Special Enrollment Notice
- Medicare Part D Notice
- Marketplace Information
- No Surprise Billing Notice
- Outbreak Period Relief Guidance
- Right to Designate PCP Patient Protection Notice
- Uniformed Services Employment and Reemployment Rights Notice
- Women's Health and Cancer Rights Act Notice