Insurance and Benefits

Ms. Betty King - 860-870-6000 Ext. 128

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Insurance Forms: Medco Prescription Mail Order Form

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CIGNA Medical Information:

1. $20 OAP Plan Description
2. $15 OAP Plan Description
3. $20 OAP Plan Description for MA Residents
4. H.S.A $2000/$4000 Plan Description
5. H.S.A. $2000/$4000 with RX Co-Pay after July 2011
6. H.S.A. $1500/$3000 Plan Description for Nurses
7. CIGNA Preventive Care Coverage
8. How to Find a Medical Provider online
9. Physician Nomination Form (if doctor is not in CIGNA network)
10. CIGNA Hotline 1-800-CIGNA24 (1-800-244-6224)

ANTHEM Dental Information:

1. Co-Insurance Dental Librarian Nurse Paraprofessional Supervisor
2. Co-Insurance with Rider A Nurse
3. Co-Insurance with Riders ABC Librarian Paraprofessional Teacher
4. Co-Insurance with Riders ABCD Supervisors
5. Full Dental Administrator
6. Full Dental Secretary Custodian Maintenance
7. Full Dental with Riders ABCD Administrator
8. Full Dental with Riders ABCD Secretary Custodian Maintenance

Flexible Spending Account (FSA)/Dependent Care Account (DCA) or Benny Card:

(updated 11/14/2011)

1. Letter of Introduction
2. FSA/DCA Reminders & DCA Plan Fact Sheet and Enrollment Form
3. Log-in Directions for First Time Users
4. Check Your Account Balance (Logging in) for Current Participants
5. Eligible and Ineligible Expenses
6. New and Replacement Benny Cards
7. FSA/DCA Claim Form and Filing Instructions

INSURANCE OPEN ENROLLMENT INFORMATION AND FORMS

Life Insurance Certificates: