General Information Health Care Anthem Blue Cross Blue Shield Delta Dental Plan Vision Service Plan Short Term Disability Plan Advanced Benefit Planning HIPPA Privacy Notice Retirement

Wright State University offers its employees group health insurance coverages including medical, dental and vision coverages. Each of the three medical coverages includes a maintenance drug benefit. Medical, dental, and vision coverages are linked coverages, i.e. an employee enrolls for all three of medical, dental and vision coverages for the employee’s covered family members. Employees pay an employee premium contribution toward the cost of these three health coverages.

All forms require Adobe Acrobat to view and may be completed on-line, then printed.

• Health Care Premiums
• Health Care Enrollment/Change Form
• Flexible Spending Account Election/Change Form

Anthem Blue Cross and Blue Shield

• Create Your MyAnthem.com Access
• Anthem Medical (out of network) Claim Form
• Summary of Anthem HMO,PPO and Traditional Plans

Health Savings Account

• Estimating Discounted Costs Under the Anthem High Deductible Health Plan
• Fifth Third Health Savings Account Brochure
• Healthcare Questions and Answers
• Healthy Rewards under the High Deductible Health Plan
• HSA Eligible/Ineligible and Deductible/Non-Deductible Medical Expenses
• HSA Salary Reduction Agreement
• HSA Employee Contribution Form
• MyHealth for Members
• Preventive Health Guidelines
• WSU HSA Arrangement with Fifth Third Bank

Delta Dental Plan Dental Benefits

• Delta Dental Plan Summary
• Dental Claim Form
  

Vision Service Plan Vision Benefits

• Vision Service Plan Summary
• Vision (out of network) Claim Form 
   

Maintenance Drug Benefits

Status of the WSU Prescription Drug Program and the WSU Pharmacy

• Network Provider Listing for Express Scripts for any HMO, PPO and Traditional Health Plans
• Prescription Claim Form
• Temporary Express Scripts ID card
• WellPoint NextRx mail service pharmacy brochure (HDHP Plan)
• WellPoint NextRx Prescription Drug Claim Form (HDHP Plan)

Photos by CTL, Will Jones, Barbara Weinert-McBee, & Michael Leschisin.

Copyright Information © 2004 | Accessibility Information
Last updated: Tue. Nov-17-09, 15:11
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