Benefits Forms & Links

Click on the titles to view information available by Benefit

                                                                                                             If you cannot read any of these files after downloading them, please call Human Resources at ext. 7757 and request the appropriate form.

To view Summary Plan Description (SPD) information for our Health & Welfare plans please visit:

Loyola University partners with Gallagher Benefits Services, Inc. (GBS) and their Benefit Advocate Center.  This broker partnership offers you assistance with claims questions and benefit issues. If you have any unresolved issues with our medical carrier (or any of our other providers), please feel free to call toll free 800-492-8005 or e-mail your Benefit Advocate Team at

2019 Medical, Dental & Vision Enrollment/Change Form

2019 Flexible Spending Account Enrollment Form

2019 Supplemental Retirement Contribution Form


Medical Insurance UnitedHealthcare 

  • UHC Website (to search in the Provider Directory, all Loyola plans use the UHC Choice Plus Network of providers)

Prescription Information

Other UHC information

Express Scripts, Inc. (ESI)/RxBenefits- prescription information

ACA Contraceptive Services

Dental Insurance - Cigna

 AlwaysCare Vision Insurance 

 Flexible Spending Account(s)- WageWorks

Life & AD&D - Lincoln Financial Group - coverage begins 1/1/2016

Lincoln Life & Long Term Disability (LTD) Form

Lincoln Life & Long Term Disability Informational Summaries

Lincoln Financial Voluntary Benefits (Annual Enrollment Only - Contact HR for information)

Group Supplemental Retirement Account

Employee Assistance Program (EAP) - Aetna Horizon Health

Tuition Remission

FACHEX/Tuition Exchange Program

EdNavigator Education Support

EdNavigator Overview and Startup Information

Adoption Assistance

Leave of Absence

Please contact Human Resources at extension 7757 to speak to a HR representative if you may need a leave of absence.

Separation Summary