Medical
Meritain Health
Policy: 13874
Phone Number: 866.300.8449
Aetna - Provider Search
- Classic Gold Banner Plan SBC | Aetna (Actives)
- Copay Gold Banner Plan SBC | Aetna (Actives) - Enrollment in Copay Gold Plan limited to current enrollment only. This plan is closed to new enrollees
- HDHP A Banner Plan SBC | Aetna (Actives/Retirees)
- Value Gold Banner Plan SBC | Aetna (Retiree plan)
- Medical Claim Form
- Nurse Health Coaching
- SkinIO - Free Virtual Skin Screening by Board-Certified Dermatologist
- Virta - Diabetes-Prediabetes-Weight
- Specialty Medication through PrudentRx
- Hinge Health
- Empower Wellness Screening Program
- Enrollment form
CVS Caremark Formulary PDF 4.2024
CVS Caremark Formulary removals and add-backs 4.2024
Médico - Español
Aetna - Provider Search
- Classic Gold Banner Plan | Aetna (Actives)
- Copay Gold Banner Plan | Aetna (Actives) - Enrollment in Copay Gold Plan limited to current enrollment only. This plan is closed to new enrollees
- HDHP A Banner Plan | Aetna (Actives/Retirees)
- Value Gold Banner Plan | Aetna (Retiree plan)
Teladoc
Meritain Health
Phone Number: 800.835.2362
- Teladoc - Complete your medical history
- Level of Care Flyer
- Teladoc Services Update
- Teladoc Extended Overview and registration
- Teladoc- Traveling
- Getting Started with Teladoc Flyer
- 6 Benefits of Teladoc
- Flu and Cold Flyer
- Teladoc care when you can't leave work
Employees enrolled in a PPO Medical plan will have a $0 copay when using Teladoc.
Employees enrolled in a HDHP Medical plan will have a $56 copay when using Teladoc.
If a Teladoc physician orders a prescription, the member is responsible for the cost of the medication.
Dental
Cigna
Policy: 3341863
Phone Number: (800) 997-1654
Cigna - Provider Search
- DHMO Schedule of Benefits and Copays
- 2023 PPO Dental Benefit Summary
- PPO Dental Certificate of Coverage
- Dental DPPO & Indemnity ADA Dental Claim Form
Dental - Español
Cigna - Provider Search
Vision
EyeMed through Delta Dental
Policy: 22155
Phone Number: (800) 352-6132
Delta Dental - Provider Search
- Vision Summary of Benefits - English
- Web Access Flyer - English
- Mobile App Flyer - English
- Hearing Discount Flyer - English
- Diabetic Flyer - English
- Vision Out of Network Claim Form
Vision - Español
EyeMed through Delta Dental
Policy: 22155
Phone Number: (800) 352-6132
Delta Dental - Provider Search
- Vision Benefit Summary - Spanish
- Web Access Flyer - Spanish
- Mobile App Flyer - Spanish
- Hearing Discount Flyer - Spanish
- Vision Out of Network Claim Form
Employee Assistance Program - English and Español
Alliance Work Partners Additional Resources
Phone number: (800) 343-3822
Website: www.awpnow.com
Additional Resources:
Health Savings Account (H.S.A.)
HealthEquity
Phone Number: (866) 346-5800
Flexible Spending Account (FSA)
Inspira Financial Website
Phone Number: (844) 729-3539
- Inspira FSA Card Flyer
- Inspira FSA Card Flyer - Spanish
- Inspira Limited Purpose FSA Flyer
- Inspira Dependent Care FSA Flyer
- Inspira Dependent Care FSA Flyer - Spanish
- Roosevelt Sch Dist 66 07-18.sum
Basic and Voluntary Life/AD&D
Standard
Phone Number: (800) 628-8600
Website: www.standard.com
Standard Continued benefit forms
Request for Group Life Conversion Materials – 31 Days: https://www.standard.com/eforms/1598a.pdf
Request for Group Life Conversion Materials – 31 Days – Spanish https: https://www.standard.com/eforms/1598a_spu.pdf
Life Portability Application: https://www.standard.com/eforms/20908.pdf
EOI can be submitted directly to Standard by clicking the EOI link EOI.
We understand that an event like this requires compassionate support. Our simple claim process and caring team along with our Life Services Toolkit can help Roosevelt and the member through this difficult time.
Claim Process
- Employer – complete the Employer Claim Form
- Beneficiary – complete the Beneficiary Statement
- Email the completed forms to lifepro@standard.com along with the required documents noted on the forms. You can also fax or mail these to the address on the claim form.
Caring Team
Our Life Claims team is specially trained in our proprietary grief communication program. We also pay for additional records such as a police report or medical records, so the beneficiary doesn’t have to (in states that allow it).
For claim questions and status:
- Contact our life claims team at lifebenefits@standard.com or 800.628.8600
- An updated report with claim status is available to Roosevelt’s via Standard’s AdminEASE portal under the Reports Online section of the Claims tab. If you need assistance with the portal, please contact our support team at 971.321.2580.
Life Services Toolkit
Standard provides beneficiaries no-cost access to a Life Services Toolkit through our partnership with Health Advocate. Click here to log in. Use “assurance” as the Username.
- Basic Life/AD&D Benefit Summary
- Basic Life/AD&D Benefit Summary - Spanish
- Voluntary Life/AD&D Benefit Summary
- Voluntary Life/AD&D Benefit Summary - Spanish
- Basic Life Certificate of Coverage
- Online Will Prep Flyer
- Online Will Prep Flyer - Spanish
- Life Services Toolkit
- Life Service Toolkit - Spanish
- Travel Assistance Flyer
- Travel Assistance Flyer - Spanish
- Group Life Conversion Application
- Group Life Conversion Application - Spanish
If electing voluntary life insurance above guarantee issue as first eligible or if electing outside initial eligibility, the employee is responsible to complete and submit the required Evidence of Insurability (EOI) form to Standard. Policy will not be effective until EOI is reviewed and approved by Standard and after receipt of first month’s premium.
Short Term Disability
Voya Financial
Phone Number: (800) 955-7736
Website: https://www.voya.com/
- Short Term Disability Benefit Summary
- Short Term Disability Certificate of Coverage
- Evidence of Insurability
- Instructions for Evidence of Insurability
- Physician Claim Form
- ER Claim Form
- STD Claim Form
If electing outside initial eligibility, the employee is responsible to complete and submit the required Evidence of Insurability (EOI) form to Voya. Policy will not be effective until EOI is reviewed and approved by Voya and after receipt of first month’s premium.
Voluntary Benefits (Accident, Critical Illness, Hospital Indemnity) - English and Español
Voya Financial
Phone Number: (800) 955-7736
Website: https://www.voya.com/
- Per Pay Period Cost - Monthly, 21 Pays and 26 Pays
- Accident Brochure
- Critical Illness Benefit Summary
- Hospital Indemnity Benefit Summary
- Wellness Brochure
- Folleto de Bienestar
- Resumen de beneficios por enfermedad grave
- Resumen de beneficios por accidente
- Resumen de beneficios de indemnización hospitalaria
403B
Marketplace Overview
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