Open Enrollment will begin on Monday, November 4th and will run through Wednesday, November 27th, 2013. Our annual Open Enrollment period provides all benefits-eligible employees an opportunity to review and/or make changes in the following benefit plans:
Flexible Spending Accounts (FSA) – Medical and Dependent Care; and
Voluntary Life, Vision and Critical Illness & Accident Insurance.
Open Enrollment Guide 2014 (Active Employees) (pdf) - This guide contains all the information you need about Open Enrollment including: plan changes, new premiums, and what you need to do during the Open Enrollment period.
Open Enrollment 2014 Presentation (pdf) - View the PowerPoint slides from the Open Enrollment presentation.
Open Enrollment Guide 2014 (Under 65 Retirees) (pdf)
Open Enrollment Guide 2014 (Medicare Over 65 Retirees) (pdf)
Open Enrollment Informational Sessions Schedule (pdf)
Medical & Prescription Premiums (Active Employees) (pdf)
HSA Qualified Health Plan Summary of Benefits & Coverage (SBC) 2014 (pdf)
HSA Qualified Health Plan Benefits-At-A-Glance 2014 (pdf)
High Deductible Wellness PPO Plan Summary of Benefits & Coverage (SBC) 2014 (pdf)
High Deductible Wellness PPO Plan Benefits-At-A-Glance 2014 (pdf)
Low Deductible PPO Plan Summary of Benefits & Coverage (SBC) 2014 (pdf)
Low Deductible PPO Plan Benefits-At-A-Glance 2014 (pdf)
Encore/Encircle Networks and Endorsed Physicians (pdf) - Use these instructions to find physicians and facilities who are in our networks and physicians who are Endorsed.
Dental Premiums (pdf)
Uniform Glossary of Medical Terms (pdf) - Not sure what deductible or out-of-pocket really means? Use this glossary to look up the meanings for common insurance terms.
Prescription Coverage Table (pdf) - This table lists the coinsurance/copays for our prescription plan.
Express Scripts Basic Preferred/Formulary List (pdf) - A list by category showing Preferred and generic drugs covered by our prescription plan.
Preventive Benefits Guidelines (pdf) - Learn more about what benefits are covered under the Affordable Care Act's preventive care provision.
Flexible Spending Plan (FSA) List of Eligible Expenses (pdf)
Health Savings Account (HSA) List of Eligible Expenses (pdf)
Chronic Disease List (pdf) - The Low Deductible & High Deductible Wellness PPO Plan have a benefit where the deductible is waived for chronic disease visits.
Tobacco-Free Affidavit (pdf) - All employees/Under 65 retirees enrolled in a Ball State health plan MUST complete and submit a new affidavit by November 27th to begin/continue the tobacco-free premium discount. We have mailed an affidavit to each employee/Under 65 retiree's home address (it is the orange form in the packet).
Health and Dental Plan Enrollment/Change Form (pdf)
Flexible Spending Plan (FSA) Enrollment Form (pdf) - Medical and/or Dependent Care. You must enroll in these plan(s) each plan year in order to continue your participation.
HSA Bank Payroll Deduction Form 2014 (pdf)
HSA Trustee Selection Form (pdf) - Use this form to initiate the opening of your HSA with HSA Bank.
The Voluntary Benefit vendors will be on campus Tuesday, November 12th from 9:00 am until 3:00 pm in the Student Center Ballroom. Please plan to attend to get information on the benefits and enroll!
VSP (Vision Benefits) Summary of Plans and Premiums (pdf) - Please note that premiums have been reduced for the Basic Coverage and that a new Premier Coverage plan has been added (for a higher premium).
VSP Enrollment Form (pdf) - Open Enrollment is the only time that you can enroll in or cancel vision coverage! You do not have to enroll each year if you want your coverage to remain the same.
MetLife Auto & Home Insurance Flyer (pdf)
The Hartford Voluntary Life Insurance Information (pdf)
The Hartford Voluntary Life Insurance Enrollment Form (pdf)
Information on Allstate's Critical Illness & Accident Insurance Coming Soon!
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800-382-8540 and 765-289-1241