Benefit Compliance
Employee Welfare Benefits Plan
The Welfare Benefits Plan Summary Plan Description [pdf] describes the benefits to which you may be entitled under the plan, your rights, and responsibilities. This document and the certificates of insurance for its underlying benefits are intended to inform eligible employees about the plan's terms and their rights under it. The specific benefits offered under the plan are:
- Summary of Material Modification - COVID [pdf]
- Welfare Benefits Plan Summary Annual Report [pdf]
- Flexible Benefits Program and Pre-Tax Premium Benefits Program [pdf]
- Long Term Disability Benefits [pdf]
- Short Term Disability Benefits [pdf]
- Voluntary Accidental Death and Dismemberment Insurance [pdf]
- Employee Assistance Program [pdf]
- Dependent Eligibility Summary [pdf]
Summaries of Benefits and Coverage (SBC) - Health Plans
- EPO Plan - 2019 SBC [pdf]
- Healthy Blue Hybrid Plan - 2019 SBC [pdf]
- High Deductible Plan - 2019 SBC [pdf]
Required Notices
- HIPAA Notice of Privacy Practices [pdf]
- Newborns' and Mothers' Health Protection Act [pdf]
- Notice of Health Insurance Exchange [pdf]
- Notices of Creditable Prescription Drug Coverage [pdf]
- Premium Assistance Under Medicaid and CHIP [pdf]
- Qualifying Life Events [pdf]
- Women's Health and Cancer Rights Act [pdf]
Health Benefit Booklets & Certificates
- EPO Plan - 2021 Booklet [pdf]*
- Hybrid Plan - 2021 Booklet [pdf]*
- High Deductible Plan - 2021 Booklet [pdf]*
Dental Benefit Certificates
- Dental Blue Low Option Certificate (no ortho) [pdf]*
- Dental Blue High Option Certificate (with ortho) [pdf]*
Group Life & Disability Insurance - Summary of Benefits
- Life and Accidental Death & Dismemberment [pdf]
- Long Term Disability [pdf]
- Short Term Disability [pdf]
*These contracts represent the benefits at the time that they are issued to St. John Fisher University. They are not to be relied upon as the official description of the benefits and Excellus Health Plan, Inc. will not routinely update them. Individual employees should refer to their actual contracts and the Excellus Customer Service Department with questions, using the telephone number listed on their Excellus BlueCross BlueShield ID cards.
Retirement Plan
The Retirement Plan Summary Plan Description [pdf] document describes the benefits to which you may be entitled under the plan, your rights, and your responsibilities. This document plus the summaries made available by the institutions sponsoring investment funds under the plan are intended to serve as a summary plan description to inform eligible employees about the plan's terms and their rights under it.