• Benefits Information

Medical Insurance Information

Current Vendor:       UMR
UMR Medical Plans Comparison (Classic vs. Premier vs. Health Savings Plan)
Medical Plan Comparison with Smart Care
UMR Medical Plan Enrollment Form
HSA Enrollment Form (to be completed only if Health Savings Plan is elected as your medical plan)
Medical Benefit Summary Plan Description (SPD) and Plan Document
Health Insurance Marketplace Coverage Options and Your Health Coverage
Health Insurance Rates
Notice of Privacy Practices
University's Health Plan Notice of Non-Discrimination
Summary of Benefits and Coverages
        Classic Plan with Smart Care and Wellness Incentive
        Classic with Smart Care
        Health Savings Plan
        Premier Plan with Smart Care and Wellness Incentive
        Premier Plan

Real Appeal: Online Weight Loss Program
Real Appeal Flyer 1
Real Appeal Flyer 2
Real Appeal Flyer 3

Dental Insurance Information

Current Vendor:       Arkansas Blue Cross Blue Shield
Dental Summary Plan Description (SPD) and Plan Document
Schedule of Benefits
Dental Enrollment Form
Dental Plan Rates

Vision Insurance Information

Current Vendor:       Superior Vision
Rates, Outline of Benefits, and Other Information
Superior Vision Enrollment Form
Member Reimbursement Form

Flexible Spending Account Information

Current Vendor:       UMR
Claim Form
Flexible Spending SPD
FSA Enrollment Form
FSA Carry Over
FSA Debit Card Information
FSA Direct Deposit Form
FSA Eligible & Ineligible Expenses
FSA Employee Guide Flyer
FSA Frequently Asked Questions
FSA Important Flex Account Information
FSA Medical Necessity Form

Prescription Coverage Information

Current Vendor:       MedIMPACT
Drug Formulary

As a reminder, the full formulary contains a large number of prescription medications, this document is only a summary of the most often prescribed generic and brand name drugs and the most often prescribed dosage of those drugs covered by The Plan. This list is not all-inclusive and is not a guarantee of coverage as the formulary may change at any time, many medications are subject to Prior Authorization review, Quantity Level Limits, or Step Therapy and are restricted to the FDA approved treatment guidelines. We recommend that members log in to Medimpact to check the coverage for a specific drug and dosage, since the website is more comprehensive and is updated more frequently than this list.

Benefits Summary
Pharmacy Appeal Process:
   Formulary Exception and Review Request Process Steps
   Formulary Request Form

Life, Long-Term Disability (LTD), and Accidental Death and Dismemberment (AD & D) Insurance Information

Current Vendor:       The Standard Insurance Company
Employee Benefits Guide
Active Employee Life Insurance Policy Document
Long Term Disability Insurance Policy Document
     Group Long Term Disability Policy Document 1/1/2016 Amendment
Accidental Death and Dismemberment Insurance Policy Document

Voluntary Products

Critical Illness Insurance provided by Met Life
MetLife Critical Illness Flyer
MetLife Critical Illness Frequently Asked Questions
Auto and Home Insurance discounts provided by Liberty Mutual
Liberty Mutual Informational Flyer
Payroll Deduction to Arkansas Superior Federal Credit Union

ID Watchdog
ID Watchdog Flyer
ID Watchdog Enrollment Flyer
Identity Theft Affects all Ages

Legal Shield Enrollment Flyer

Family Medical Leave Act (FMLA) Information

Employee Rights and Responsibilities
Request (for foreseeable FMLA leave)
Leave Notice Acknowledgment (for unforeseeable FMLA leave)

Catastrophic (CAT) Leave Plan Information

Faculty Leave Bank Program Information
Staff Leave Bank Program Information
Donation Form
Liability Agreement
Physician’s Certification

General Information

Annual Safety Report Acknowledgement Form
Benefit Sheet - 9 Month
Benefit Sheet - 10.5 Month
Benefit Sheet - 12 Month
COBRA Provider – Conexis
Fee Waiver Request for Employee
Fee Waiver Request for Spouse/Dependent
Holiday Schedule
Leave Without Pay Request Form
Performance Evaluation Form
Prior Approval Overtime Request Form
Request for Leave
Staff Handbook
Summary of Fringe Benefits
Vehicle Safety Program
Whistleblower Act Poster