大象传媒

Benefits Forms & Resources

Provider Contact Info

• Benefits providers contact information

Forms

• Dental Claim Reimbursement
• Vision Claim Reimbursement
• Medical/Pharmacy Claim Reimbursement (for service date prior to May 1, 2025: contact benefits@andrews.edu)
• Flex Spending Reimbursement
• Health Savings Account Response Form
• FMLA Leave Request
• Tuition Assistance
• Free Class Form
• Gift of Time (Recipient)
• Gift of Time (Donor)
• Flu Shot Form

Resources & Misc Benefits

Plan Documents, Certificates, and Information

• Medical Plan Document & Summary Plan Description (SPD)
• Dental/Vision Employee Benefit Plan Document
• Group Long Term Disability Certificate
• Group Life & ADD Certificate
• Group Accident Plan Contract
• Group Critical Illness Contract
• Current Plan Year Information (under "Information" section)
• New Plan Year Info

HMA (Medical & Rx)

• Drexi (Pharmacy Benefits Manager)
  • Welcome Information
  • Member App
  • Advocacy & International
  • Reimbursement Form

UNUM Benefits

• How to file a claim
• Medical Bill Saver
• Employee Assistance Program (EAP) & Work/Life Balance - Q&A
• Travel Assistance
• Beneficiary Information
• Portability
• Voluntary Benefits
  • Accident Plan
  • Critical Illness
  • Hospital Insurance

Other Benefits

• Legal Resources
  • Legal Plan Benefit
  • Interactive Brochure
• Samaritan Fund