Benefits Forms & Links
Click on the titles to view information available by Benefit
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Voluntary Benefits (Critical Illness, Hospital Indemnity & Accident)
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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: /human-resources/benefit-summary-plan-descriptions
2026 Benefits Guide
Medical Insurance - UnitedHealthcare
- UHC Website (to search in the Provider Directory, all Loyola plans use the UHC Choice Plus Network of providers)
- UnitedHealthcare Select Member Network Resource Guide
Other UHC information
- Transition of Care Form
- Provider Nomination Form
- Why is UHC calling me? Wellness & Disease Management Program Information
- UHC Health4Me app Information
- Behavioral Health Virtual Visit Trifold Flyer
- SafeTrip Travel- International Medical Coverage for Emergency Health Services Only
- UHC & Ochsner Fitness Center Membership - Discounted membership rate for UHC members. If interested, email ofc@ochsner.org or call 504-733-1600 and select option 2. Proof of insurance required for discounted membership.
Machine-Readable Files:
We are committed to supporting the Transparency in Coverage Rule by making MRFs (machine-readable files) available to you. UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of Loyola University New Orleans.
To link to the Machine-Readable Files, please click on the URL provided: transparency-in-coverage.uhc.com
Pharmacy Coverage - Express Scripts (by Evernorth)
- express-scripts.com
- 2026 Express Scripts National Preferred Formulary
- Express Scripts Mail Order information
- Specialty Medication through Accredo
Customer Care Number: 800-282-2881
ACA Contraceptive Services
- Contact Express Scripts Pharmacy at 866-237-0703 for the coverage details
Dental Insurance - Cigna
- Cigna Webpage
- DHMO Benefit Summary
- DHMO Plan Brochure
- DHMO Preventative Care Brochure
- DHMO Charge Schedule
- High DPPO Benefit Summary
- High DPPO Benefit Summary - TX
- Mid DPPO Benefit Summary
- Mid DPPO Benefit Summary - TX
- Benefit Summary (TX Residents)
- DPPO Plan Brochure
- PPO Claim Form
- PPO ID Card (generic)
- Privacy Notice
Vision Insurance - UNUM (formerly AlwaysCare)
Flexible Spending Account(s) - Associated Bank (effective 1.1.2026)
- Associated Bank Website
- How to file a claim flyer
- Direct Deposit Authorization Form
- Healthcare FSA info flyer
- FSA Store flyer
WageWorks
- WageWorks website
- WageWorks FSA Guide Website
- Health Care FSA Overview
- Dependent Care FSA Overview
- WageWorks Dependent Care FSA Website
- EZ Receipts FSA Mobile app
- FSA Store Flyer
- FSA Quick Start Guide
Life & AD&D - Lincoln Financial Group
Lincoln Life & Long Term Disability (LTD) Form
- Life & LTD Enrollment & Change Form
- Online Evidence of Insurability Form - Use Group # LOYOUNIVST
- Change of Beneficiary Form
- Evidence Of Insurability Form (for amounts over guaranteed issue only)
- TravelConnect Program Description
- Lincoln TravelConnect Brochure with ID Card
- TravelConnect Website Login Instructions
- Lincoln LifeKeys Brochure
- Lincoln Connect Slim Jim Brochure
Lincoln Life & Long Term Disability Informational Summaries
- Group Term Life (GTL) - Employee Coverage (University Paid) & Basic Dependent Term Life Coverage (Employee & University Share the cost)
- Voluntary Term Life 1-3x - Employee Paid (includes voluntary spouse and child coverage)
- Voluntary AD&D 1-10x - Employee Paid (includes employee or employee & family coverage)
- Long Term Disability (Taxable)
- Long Term Disability (non-Taxable)
- Lincoln LTD Progressive Income Brochure
- Lincoln Financial Group Privacy Practices Notice 2022
Lincoln Voluntary Benefits
- Lincoln Critical Illness Covreage Summary
- Lincoln Accident Insurance Summary
- Lincoln Hospital Indemnity Insurance Summary
- Lincoln Voluntary Benefits Claim Instructions
Retirement Account Information
- Change your contriubtion rate online: TIAA.org/LOYNO
- Choosing Your Investments Brochure
- Managing Your Accounts Online Brochure
- Marital Status Verification Form
- Online Enrollment Brochure
- TIAA-CREF Change of Address
- TIAA-CREF Roth Option Brochure
Employee Assistance Program (EAP) - Aetna Horizon Health
- EAP Website
- Username - loyola
- Password - eap
- Video - Resources and Services available through the EAP
- EAP Brochure
- EAP Flyer
Tuition Remission
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Online Tuition Waiver Form now located on the SSO Apps Page. Search "Tuition Waiver" after you log in.
- Statement of Dependency (Dangling Semester)
- Tax Dependency Affidavit
FACHEX/Tuition Exchange Program
- Policy Information
- Tuition Exchange Program Policy and Procedure
- FACHEX/TEP Export Student Application
Audubon Institute
- Audubon Institute Discount - 10% discount offered to Loyola Employees (this can be applied at an Audubon Membership office. Please present your Loyola ID for the membership discount).
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.