Select Benefits Plan (Ben Pay)

This plan is only available to benefit-eligible employees as of December 2007 who elected to remain "grandfathered" in the Ben Pay funding mechanism model during the open enrollment period. This plan will be phased out over a four-year period with all faculty and non-classified staff covered under the Cost Share funding mechanism plan by January 1, 2012.

Summary Plan Booklet (Ben Pay)
This booklet contains medical, dental, life insurance, and retirement plan information.

Provider Quick Reference Sheet

Benefits Enrollment Change Forms

• Ben Pay Change Form
• Life Insurance Application
• New Benefits Discount
• Savings Bond Enrollment Form

Claim Forms

• Anthem Mail Order Prescription Form
• Anthem Medical Claims
• Anthem Prescription Claims
• EBMS Dental Claim Form
• Dependent Care Flexible Spending Account
• Healthcare Flexible Spending Account

Anthem Ancilliary Benefits

• Anthem Rewards
• Healthy Solutions
• Special Offers
• 24-Hour Nurse Line

Certificates of Insurance

• Anthem Gold Plan
• Anthem Green Plan
• Anthem POS Plan

Medicare Part D Notice