Five College Consortium

Benefits

Summaries and Description
Five Colleges Health and Dental Insurance Information 2018
Delta Dental PPO Subscriber's Certificate
HRA for the 2018 Health Plan

Harvard Pilgrim HMO Schedule of Benefits
Harvard Pilgrim Plan Information
Harvard Pilgrim Pediatric Dental HMO Information
Harvard Pilgrim PPO Schedule of Benefits
Harvard Pilgrim PPO Plan Information
Harvard Pilgrim PPO Pediatric Dental Benefit
Harvard Pilgrim 5 Tier Prescription Information
Harvard Pilgrim Doctor on Demand FAQ
Harvard Pilgrim Doctor on Demand Information
Harvard Pilgrim-Know iCare
Preventative Care Information
HIPAA Privacy Notice Updated for September 23 2013
Affordable Care Act - Health Insurance Marketplace Coverage Options

Health Reimbursement HMO (HRA) Welcome Letter
Health Reimbursement (HRA) Summary (SBC)
Health Reimbursement PPO (HRA) Welcome Letter
Health Reimbursement PPO (HrA) Summary (SBC)

Election Form Health FSA March 17 2016
Flexible Spending Summary (FSA) Plan Description (SPD) (Effective 1/1/2014)
Flexible Spending Summary (FSA) Amended & Restated Plan Document (Effective 1/1/2014)
FSA/HRA HIPAA Privacy Notice 09-23-2013

403B Retirement Summary Annual Report 2016 (SAR)
403B Retirement Plan Summary Plan Description 7/1/2014 (SPD)
Emeriti Summary Annual Report 2016 (SAR)
Emeriti Plan Highlights
Emeriti Summary Plan Description (SPD)
Summary of Material Modifications
Five Colleges Group Life Insurance Plan and Monthly Disability Plan

Forms

Agreement for Salary Reduction under Section 403(b)
HRA Claim Form
Employee Tuition Waiver Request Form
Affidavit of Domestic Partnership Form
Transportation Subsidy Enrollment Form


Leaves

Employee Application for Medical Leave
Medical Leave Physician Statement
Medical Leave Return to Work Physician Statement
Statement in Support of Need for Domestic Violence Leave