Benefits Guide and Rates
Benefits Election/Change Summary
Legal Shield (Pre-Paid Legal Service/IdentityTheft Shield Plan)
Flexible Spending Account - Health Care and Dependent Care Plan
Summary Annual Report
- 2014 Benefits Guide
- 2014 Monthly Health Insurance Rates
- 2014 Insurance Providers Contact Information
- 2014 Benefits Election/Change Summary (Form #3075) (Word version)
- 2014 Benefits Election/Change Summary (Form #3075) (Adobe version)
- Affidavit of Domestic Partner Benefits (Form #3032)
- AHL PPO Enrollment Application
- HAP HMO Enrollment Application (see NOTE below)
- HAP Membership and Record Change Form
NOTE: HAP HMO Enrollment Application must include HAP HMO Personal Care Physician's Name and PCPIN information available on the HAP web site at www.hap.org.
The Summary of Benefits and Coverage documents below show what the medical plans cover and what they cost.
AHL PPO Plan Information:
HAP HMO Plan Information:
- Summary of Benefits and Coverage:
- HAP HMO Schedule of Benefits
- HAP HMO Aspire Health Engagement Membership Guide and Requirements
HAP/AHL Pharmacy Mail Order Information
NOTE: Indicate your 2014 FSA Health Care and/or Dependent Care election(s) on the 2014 Benefits Election/Change Summary Form #3075 (above)
NOTE: Complete the 2014 RSA Insurance Election/Change Form #3076 below and the HAP HMO Enrollment Application, dental and vision insurance forms above for coverage. Return all forms to the Office of Human Resources.
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.