Plan Documents and Legal Notices

Plan Documents

Voya – Accident Insurance Plan Summary
Voya – Accident Insurance Certificate of Coverage
Voya – How To File A Claim

Voya – Critical Illness Insurance Plan Summary
Voya – Critical Illness Insurance Certificate of Coverage
Voya – Critical Illness Insurance Wellness Benefit
Voya – How To File A Claim
Voya – Critical Illness Attending Physician Statement

Delta Dental – Benefit Summary
Delta Dental – Evidence of Coverage

Magellan – EAP Evidence of Coverage

Lennox – Adoption Reimbursement Program
Lennox – Adoption Reimbursement Form

2024

TaxSaver – 2024 FSA Benefit Summary
TaxSaver – Standard FSA Claim Form
Lennox – FSA Flex Debit Card Information

2025

TaxSaver – 2025 FSA Benefit Summary

Sedgwick Short-Term Disability Plan Description – Salaried Employees
Sedgwick Short-Term Disability Plan Description – Hourly Employees

New York Life Long-Term Disability Benefit Summary – Salaried Employees
New York Life Long-Term Disability Plan Description – Salaried Employees

New York Life Long-Term Disability Benefit Summary – Hourly Employees
New York Life Long-Term Disability Plan Description – Hourly Employees

Voya – Life and AD&D Certificate of Coverage
Voya – How To File A Claim

2024

2024 Green Plan Summary of Benefits and Coverage
2024 Green Medical Plan SPD
2024 Blue Plan Summary of Benefits and Coverage
2024 Blue Medical Plan SPD
Lennox – 2024 Tobacco Use Affidavit
Lennox – 2024 Working Spouse Affidavit

2025

2025 Green Plan Summary of Benefits and Coverage
2025 Blue Plan Summary of Benefits and Coverage
Lennox – 2025 Tobacco Use Affidavit
Lennox – 2025 Working Spouse Affidavit

Lennox – Volunteer Time Off Benefit
Lennox – Well-Being Time Off Benefit

2024

OptumRx – Premium Standard Formulary List (as of 7/1/24)
OptumRx – Premium Formulary Exclusion List (as of 1/1/24)

2025

OptumRx – 2025 Premium Standard Formulary List
OptumRx – 2025 Premium Standard Formulary List (Preventive Generics)
OptumRx – 2025 Premium Standard Formulary List (PA Required)
OptumRx – 2025 Premium Standard Formulary List (Quantity Limits)
OptumRx – 2025 Premium Standard Formulary List (Step Therapy)
OptumRx – 2025 Premium Formulary Exclusion List

EyeMed – Vision Benefit Summary (English)
EyeMed – Vision Benefit Summary (Spanish)

Legal Notices

2025 Required Notices – All Active Employees
2025 Wellness Notice
2025 CHIP Notice
2025 Health Insurance Marketplace Notice
2025 Medicare Part D – Women’s Health and Cancer Rights
State of Illinois Essential Health Benefit Listing
Your Rights and Protections Against Surprise Medical Bills
2023 Consolidated Pension Plan Annual Funding Notice
2023 Manufacturing Pension Plan Annual Funding Notice