Loyola University Maryland

Office of Human Resources

Summary Plan Descriptions

LUMD 403b Summary Plan Description

LUMD Retirement Plan Summary of Material Modifications Effective January 1, 2018

LUMD Health and Welfare Benefit Plan

LUMD Health & Welfare Benefit Plan Appendix

LUMD Health & Welfare Summary of Material Modifications Effective July 1, 2020

Summary of Benefits

This chart provides a summary of the benefits available under Loyola University Maryland 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

Medical OAP Plan

OAP Certificate Rider - July 2022

OAP Certificate Rider MA - July 2022

OAP Compliance Rider - July 2022

Summary of Benefits and Coverage "SBC"July 1, 2023

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 - July 1, 2022

OAP-IN Certificate Rider MA - July 1, 2022

OAP-IN Compliance Rider - July 1, 2022

Summary of Benefits and Coverage "SBC" -  July 1, 2023

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 - July 1, 2022

OAP HDHP Compliance Rider - July 1, 2022

Summary of Benefits and Coverage "SBC" - July 1, 2023

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 - Jan. 1, 2019

Certificate Rider - April 1, 2019

Certificate Rider July 1, 2020

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 - Jan. 1, 2019

Certificate Rider  - April 1, 2019

Certificate Rider - July 1, 2020

2020-2021 Dental Copay Rider - Copay Schedule

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 (Benefit Maximum $ 250,000)

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 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

HFSA SMM Effective July 1, 2020

Optum Financial

307 International Circle, Suite 200

Hunt Valley, MD 21030

Health Care and Dependent Care Flexible Benefits Plan 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.