Plan Documents & Legal Notices

Understanding your benefit plans is essential. Please review the following documents and notices.

Plan Summaries, Affidavits, Certificates of Coverage

Accident Insurance

2025 / 2026

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

Adoption Assistance

2025 / 2026

Lennox – Adoption Reimbursement Program
Lennox – Adoption Reimbursement Form

Critical Illness Insurance

2025 / 2026

Voya – Critical Illness Insurance Plan Summary
Voya – Critical Illness Insurance Certificate of Coverage
Voya – Critical Illness Insurance $100 Wellness Benefit
Voya – Critical Illness Attending Physician Statement
Voya – How To File A Claim
Voya – How To Identify Claims Opportunities

Dental

2025 / 2026

Delta Dental – Benefit Summary
Delta Dental – Evidence of Coverage

Flexible Spending Account (FSA)

2025 / 2026

TaxSaver – 2025 FSA Benefit Summary
TaxSaver – Standard FSA Claim Form
Lennox – FSA Flex Debit Card Information

LEAVE OF ABSENCE - DISABILITY (STD, LTD)

2025 / 2026

Sedgwick – Short-Term Disability SPD (Salaried)
Sedgwick – Short-Term Disability SPD (Hourly)

New York Life – Long-Term Disability Benefit Summary (Salaried – Class 1)
New York Life – Long-Term Disability SPD (Salaried – Class 1)

New York Life – Long-Term Disability Benefit Summary (Hourly – Class 2)
New York Life – Long-Term Disability SPD (Hourly – Class 2)

LIFE INSURANCE AND AD&D

2025 / 2026

Voya – Life and AD&D Certificate of Coverage (Non-Union)
Voya – How To File A Claim

Medical

2026

UMR – 2026 Blue Plan Benefits Summary
UMR – 2026 Green Plan Benefits Summary
Lennox – 2026 Tobacco Use Affidavit
Lennox – 2026 Working Spouse Affidavit

2025

UMR – 2025 Green Plan Benefits Summary
UMR – 2025 Green Plan SPD
UMR – 2025 Blue Plan Benefits Summary
UMR – 2025 Blue Plan SPD
Lennox – 2025 Tobacco Use Affidavit
Lennox – 2025 Working Spouse Affidavit

Paid Time Off

2025 / 2026

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

Prescription Drug (Rx)

2025

Effective January 1, 2025
OptumRx – 01.2025 Premium Standard Formulary
OptumRx – 01.2025 Premium Standard Formulary (Preventive Generics)
OptumRx – 01.2025 Premium Standard Formulary (PA Required)
OptumRx – 01.2025 Premium Standard Formulary (Quantity Limits)
OptumRx – 01.2025 Premium Standard Formulary (Step Therapy)
OptumRx – 01.2025 Premium Formulary Exclusion

Effective July 1, 2025
OptumRx – 07.2025 Premium Standard Formulary
OptumRx – 07.2025 Premium Standard Formulary (PA Required)
OptumRx – 07.2025 Premium Standard Formulary (Quantity Limits)
OptumRx – 07.2025 Premium Standard Formulary (Step Therapy)

Tuition Assistance

2025 / 2026

Lennox – Tuition Assistance Program Summary
Lennox – Tuition Assistance Program FAQs

Vision

2025 / 2026

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

2025 Legal Notices

2025 Lennox Required Notice Overview – All Active Employees
2025 LIIveWell Wellness Program Notice
2025 Medicaid & CHIP Notice
2025 Health Insurance Marketplace Notice
2025 Medicare Rx / WHCRA / HIPAA Privacy Notice
2025 State of Illinois Essential Health Benefit Listing
Your Rights and Protections Against Surprise Medical Bills

2026 Legal Notices

2026 Lennox Required Notice Overview – All Active Employees
2026 LIIveWell Wellness Program Notice
2026 Medicaid & CHIP Required Notice
2026 Health Insurance Marketplace Notice
2026 Medicare Rx Options / WHCRA Benefits / HIPAA Privacy
2026 State of Illinois Essential Health Benefit Listing