91³Ô¹ÏÍø

Benefits Plan Documents and Plan Summaries

This chart provides a summary of the benefits available under 91³Ô¹ÏÍø Health & Welfare Benefit Plan. The benefit guides and insurance certificates listed below provide detailed information on the benefits available and are incorporated by reference into this Summary Plan Description. Please use the list below to identify the incorporated documents for the benefits in which you are enrolled. Please review this information carefully. If you have questions, need additional information, or wish to request a paper copy of the SPDs free of charge, please contact the Office of Benefits and Wellness at 410-617-1365.

Benefit	Insurer or Claims Administrator	Title of Benefit Booklet, Guide or Certificate
Health and Welfare Benefit Plan Wrap Document H&W Wrap Document Appendix July 2020 H&W Wrap Document Appendix July 2023	91³Ô¹ÏÍø, 4501 N Charles Street, Baltimore MD 21210	91³Ô¹ÏÍø Health & Welfare Benefit Plan
Medical OAP Plan  OAP Certificate Rider  OAP Certificate Rider MA  OAP Compliance Rider  Summary of Benefits and Coverage "SBC"	Cigna Health and Life Insurance Company Hartford, CT 06152	Open Access Plus Medical Benefits
Medical OAP-IN Plan  Vision Benefit Certificate OAP-IN Certificate Rider  OAP-IN Certificate Rider MA  OAP-IN Compliance Rider  Summary of Benefits and Coverage "SBC"	Cigna Health and Life Insurance Company Hartford, CT 06152	Open Access Plus In Network Medical Benefits
Medical OAP HDHP Plan Vision Benefit Certificate OAP HDHP Certificate Rider MA  OAP HDHP Compliance Rider  Summary of Benefits and Coverage "SBC"	Cigna Health and Life Insurance Company Hartford, CT 06152	Open Access Plus Medical Benefits, Qualified High Deductive Health Plan
Dental PPO Dental Certificate Rider - LDA Dental Certificate Addendum Certificate Rider  Certificate Rider  Certificate Rider	Metropolitan Life Insurance Company 200 Park Avenue New York, New York 10166	Your Employee Benefit Plan Dental Expense Benefits PPO Dental Plan
Dental Copay Plan Dental Certificate Rider - LDA Dental Certificate Addendum Certificate Rider  Certificate Rider   Certificate Rider	Metropolitan Life Insurance Company 200 Park Avenue New York, New York 10166	Your Benefit Plan Copay Dental Plan
Core Vision	Mid-Atlantic Vision Service Plan, Inc. 3333 Quality Drive Rancho Cordova, CA 95670	Group Vision Care Policy Certificate of Coverage
Vision Buy-up	Mid-Atlantic Vision Service Plan, Inc. 3333 Quality Drive Rancho Cordova, CA 95670	Group Vision Care Policy Certificate of Coverage
Core Life Insurance/AD&D Class 1 (Benefit Capped at $ 50,000	Symetra Life Insurance Company 777 108th Ave., NE, Suite 1200 Bellevue, WA 98004-5135	Group Term Life, AD&D, Supplemental Life, and Dependent Life Certificate of Insurance for Employees Capping the Benefit Amount to $ 50,000
Core Life Insurance/AD&D, Supplemental Life, and Dependent Life Class 2	Symetra Life Insurance Company 777 108th Ave., NE., Suite 1200 Bellevue, WA 98004-5135	Group Term Life, AD&D, Supplemental Life, and Dependent Life Certificate of Insurance for Employees Electing the Maximum Benefit Amount of $ 250,000
Core and Buy-up Long-Term Disability Insurance Class 1 – Non 403b	Symetra Life Insurance Company 777 108th Ave., NE, Suite 1200 Bellevue, WA 98004-5135	Core and Buy-up LTD  Insurance for Employees Not Receiving Loyola's 403b Contribution
Core and Buy-u Long-Term Disability Insurance Class 2 – 403b	Symetra Life Insurance Company 777 108th Ave., NE, Suite 1200 Bellevue, WA 98004-5135	Core and Buy-up LTD Insurance for Employees Receiving Loyola's 403b Contribution
Employee Assistance Program	Acentra Health 777 East Park Drive Harrisburg, PA 17111	Employee Assistance Program
Flexible Spending Accounts	Optum Financial 307 International Circle, Suite 200 Hunt Valley, MD 21030	Health Care and Dependent Care Flexible Benefits Plan Summary Plan Description
91³Ô¹ÏÍø Retirement Plan	TIAA P.O. Box 1273  Charlotte, NC 28201	Summary Plan Description

 

This website provides a summary of the benefits available. The University reserves the right to modify, amend, suspend or terminate any plan at any time, and for any reason without prior notification. You will be notified of any changes to these plans and how they affect your benefits, if at all. The plans described on this website are governed by insurance contracts and plan documents, which are available for examination. We have attempted to make explanations of the plans on this website as accurate as possible. However, should there be a discrepancy between this website and the provisions of the insurance contracts or plan documents, the provisions of the insurance contracts or plan documents will govern. In addition, you should not rely on any oral descriptions of these plans, since the written descriptions in the insurance contracts and plan documents will always govern.