Legal Shield (Pre-Paid Legal Service/IdentityTheft Shield Plan)
Flexible Spending Account - Health and Dependent Plan
Waiver of Insurance and Certification of Other Coverage
Summary Annual Report (All Plans)
- Welcome to 2013 Benefits Open Enrollment
- 2013 Benefits Open Enrollment Newsletter
- 2013 Benefits Guide
- 2013 Monthly Health Insurance Rates
- 2013 Insurance Providers Contact Information
- 2013 Benefits Election/Change Summary (Form #3075)
- Affidavit of Domestic Partner Benefits (Form #3032)
Note: BCN HBL HMO enrollments must include BCN Primary Care doctor's Name, NPI Code and Location. Locate your BCN doctor's information at http://www.bcbsm.com/index/common/find-a-doctor.html.
- BCN Healthy Blue Living HMO Guide & Requirements
- BCN Healthy Blue Living HMO - Schedule of Benefits Summary
- BCBSM Simply Blue PPO - Schedule of Benefits and Blue Preferred Rx Prescription Drug Summary
- Medco Pharmacy Mail Order Form
The Summary of Benefits and Coverage (SBC) documents summarize what the plan covers and what the plan cost. Download a copy of the following SBC documents:
Request a paper copy of the SBC documents free of charge by emailing email@example.com
- 2013 FSA - Health Care or Dependent Care Election (Form #3013)
- WageWorks Health Care Claim Form
- WageWorks Dependent Care Claim Form
- Summary Annual Reports (Health, Life/AD&D/Long Term Disability, LTU DC Retirement Plan and LTU TDA Plan)
Lawrence Tech in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.
Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Office of Human Resources reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern. Lawrence Tech in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents.