Faculty Benefits

Graphical Version

Faculty Benefits

CHEIBA FORMS/DOCUMENTS

Anthem Medical/Dental/Vision
2018 Anthem Enrollment/Change Form

PDF version

Text only version


CHEIBA Waiver of Insurance

PDF version

Text only version


Flu Shot Reimbursement Form

PDF version

Text only version



Anthem Basic Life
Anthem Basic Life Insurance Enrollment Form

PDF version

Text only version


Anthem Basic Life Insurance Beneficiary Enrollment

PDF version

Text only version

CHUBB Travel / Accident Insurance
CHUBB Beneficiary Enrollment Form

PDF version

Text only version



Flexible Spending Acct - 24Hour Flex
2017 Flexible Spending Account Enrollment Form

PDF version

Text only version


2017 24Hour Flex Enrollment Guide

PDF version

Text only version



Domestic Partnership Information and Forms
Statement of Termination of Domestic Partnership

PDF version

Text only version



Dependent Eligibility Verification Documents and Forms
Dependent Eligibility Verification Requirements

PDF version

Text only version


Affidavit of Common Law Marriage

PDF version

Text only version

Certificates of Coverage
2014 Final Custom Plus Certificate

PDF version

Text only version


2014 Final HMO-POS Certificate

PDF version

Text only version


2014 Final Prime PPO Certificate

PDF version

Text only version



2017 Open Enrollment
How to Locate a PPO Primary Care Physician (PCP)

PDF version

Text only version


2018 Open Enrollment
2018 Plan Change Summary

PDF version

Text only version


2018 Flexible Spending Enrollment Form

PDF version

Text only version


2018 Voluntary Life Insurance Packet

PDF version

Text only version



Voluntary Life / AD&D
Anthem Life Voluntary Life Insurance

PDF version

Text only version


Mutual of Omaha Accidental Death & Dismemberment Form

PDF version

Text only version




 

 

 

 

 

 

 

 

 

 

2017 CHEIBA Documents
CHEIBA Booklet 2017

PDF version

Text only version


2017 Rate Sheet

PDF version

Text only version


Anthem Multi-plan Summary

PDF version

Text only version

CHEIBA Booklet 2017 by Section
Benefit Plan Contacts

PDF version

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Introduction

PDF version

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Benefit Eligibility

PDF version

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Benefit Highlights

PDF version

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Medical Insurance

PDF version

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Dental Insurance

PDF version

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Vision Insurance

PDF version

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Basic Term Life Insurance

PDF version

Text only version


Voluntary Term Life Insurance and AD&D

PDF version

Text only version


Flexible Benefit Plan

PDF version

Text only version


Long Term Disability Insurance

PDF version

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Employee Assistance Program

PDF version

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Travel Accident Insurance

PDF version

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Glossary of Terms

PDF version

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Legal Notices

PDF version

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Summary of Benefits and Coverage
Blue Priority HMO Plan

PDF version

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HMO/Point of Service Plan

PDF version

Text only version


Prime Blue Priority PPO Plan

PDF version

Text only version


Custom Plus Plan

PDF version

Text only version


Lumenos HSA Plan

PDF version

Text only version




2016 CHEIBA Documents
CHEIBA Booklet 2016

PDF version

Text only version


2016 Rate Sheet

PDF version

Text only version



 

 

 

 

 

 

 

 

 

 

 

 


 

CHEIBA Links CHEIBA Well-Being/Wellness Flyers
Anthem Website and Physician Locator
Participant Advocate Link (PAL)

PDF version

Text only version



CHEIBA Information
COBRA Notice

PDF version

Text only version


Medicare Part D Notice

PDF version

Text only version


 

Anthem Flu Shot Information

PDF version

Text only version


Emergency Care

PDF version

Text only version


24/7 Nurse Line

PDF version

Text only version


Who Gets Diabetes

PDF version

Text only version


High Cholesterol Overview
Cholesterol Lowering Foods

PDF version

Text only version

 


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