All benefit change requests are processed in the Maxwell Health online benefits platform. Employees can access Maxwell Health to request changes and view their current benefit elections via the .
Employee Benefits
Important: a must be reported to the Human Resources office within 30 days of the event, or the requested benefit change(s) will not become effective until the next Open Enrollment period.
The following information and forms are in .pdf format unless otherwise noted. Acrobat Reader is needed to download .pdf forms.
- Change of Address/Personal Information Form (.pdf)
- Local Earned Income Tax (.pdf)
- Should be completed when submitting an address change.
- Local Earned Income Tax (.pdf)
- 2024 Plan Year Benefit Deduction Rates (.pdf)
- 2022 SAR for 重口味SM Comprehensive Welfare Benefits Plan (.pdf)
- PPO $400 Deductible Summary of Benefits and Coverage (.pdf)
- PPO $400 Deductible Quick Fact Sheet (.pdf)
- PPO $400 Booklet (.pdf)
- PPO $400 Shared Services SPD (.pdf)
- PPO $400 Shared Services Health Plan Summary Annual Report (.pdf)
- PPO $400 Claim Form (.pdf)
- Mail Order Pharmacy Application (.pdf)
- Tier Zero Prescription Drugs (.pdf)
- 2012-2013 Summary of Materials Modifications (.pdf)
- 2013-2014 Summary of Materials Modifications (.pdf)
- 2014-2015 Summary of Materials Modifications (.pdf)
- 2016-2017 Summary of Materials Modifications (.pdf)
- 2017-2018 Summary of Materials Modifications (.pdf)
Phone Number: 1-800-241-5704
- PPO $2000 Deductible Summary of Benefits and Coverage (.pdf)
- PPO $2000 Quick Fact Sheet (.pdf)
- PPO $2000 Booklet (.pdf)
- PPO $2000 Shared Services SPD (.pdf)
- PPO $2000 Shared Services Health Plan Summary Annual Report (.pdf)
- PPO $2000 Claim Form (.pdf)
- Mail Order Pharmacy Application (.pdf)
- Tier Zero Prescription Drugs (.pdf)
Phone Number: 1-800-241-5704
- Basic Dental Booklet (.pdf)
- Enhanced Dental Booklet (.pdf)
- 2013 United Concordia Summary of Material Modifications (.pdf)
- Identification Card Information (.pdf)
Phone Number: 1-800-332-0366
- Benefits Summary (.pdf)
- Smart Buyer Sell Sheet (.pdf)
- Out of Network NVA Claim Form (.pdf)
- Print your NVA ID Card (.pdf)
Health Care Reform - Over the Counter Changes
Phone Number: 1-888-868-FLEX (3539)The tuition remission application can now be completed online through the . To submit your application, log in to the portal. Under the 鈥淓mployees鈥� tab at the top of the page, use the dropdown and select 鈥淓mployee Resources鈥�. The link to the online application is listed under the Employee Self Service module as 鈥淭uition Remission.鈥� Complete all required fields and submit. Your application will be reviewed by the Human Resources department to ensure you are eligible for the benefit, and then forwarded to the Financial Aid office for final review.
*Please note: Employees requesting remission for spouses or dependents who are currently not listed as beneficiaries will need to add them. Employees can add beneficiaries by selecting 鈥淏enefits and Deductions鈥� in Employee Self Service, then selecting 鈥淏eneficiaries and Dependents - Add a New Person." Complete the required fields and select 鈥淪ubmit Changes.鈥�
Please contact Kelly Beishline with questions on benefit eligibility and accessing the application. For questions regarding a bill, please contact the Financial Aid office.