Sun Life Family Health Center Benefits Book 2017

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If you live in one of the following states, you may be eligible for assistance paying
your employer health plan premiums. The following list of states is current as of July 31, 2016.
Contact your State for more information on eligibility –
OKLAHOMA – Medicaid and CHIP Website: Phone: 1-888-365-3742
OREGON – Medicaid Website:
Phone: 1-800-699-9075
PENNSYLVANIA – Medicaid Website: Phone: 1-800-692-7462
RHODE ISLAND – Medicaid Website: Phone: 401-462-5300
SOUTH CAROLINA - Medicaid Website: . Phone: 1-888-549-0820
SOUTH DAKOTA - Medicaid Website: . Phone: 1-888-828-0059
TEXAS - Medicaid Website: Phone: 1-800-440-0493
UTAH - Medicaid and CHIP Website:
Medicaid:
CHIP: Phone: 1-877-543-7669
VERMONT - Medicaid Website: Phone: 800-250-8427
VIRGINIA - Medicaid and CHIP Medicaid Website:
Medicaid Phone: 1-800-432-5924
CHIP Website: CHIP
Phone: 1-855-242-8282
WASHINGTON - Medicaid Website: Phone:
1-800-562-3022, ext. 15473
WEST VIRGINIA - Medicaid Website:
Phone: 1-877-598-5820, HMS 3rd Party Liability
WISCONSIN - Medicaid and CHIP Website:
Phone: 1-800-362-3002
WYOMING - Medicaid Website: Phone: 307-777-7531
To see if any other states have added a premium assistance program since July 31, 2016,
or for more information on special enrollment rights, contact either:
U.S. Department of Labor
Employee Benefits Security Administration
www.dol.gov/ebsa
1-866-444-EBSA (3272)
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
www.cms.hhs.gov
1-877-267-2323, Menu Option 4, Ext. 61565
Contact Information
Plan Contact Phone Number Website
Angela Schlosser Claims Advocate (520) 321-7503
Medical Group No: 3334004 Cigna (800) 244-6224
Health Savings Account (HSA) Cigna (800) 244-6224
Dental Group No: Cigna (800) 244-6224
Vision Group No: 12141080 VSP (800) 877-7195
Flexible Spending Accounts (FSA) Payflex (800) 284-4885
Life & AD&D Insurance Group No:52209 Prudential (888) 598-5671
Short-Term & Long-Term Disability
Insurance Group No: 52209 Prudential (888) 598-5671
403(b) Retirement Savings Plan
Group No: 6-10748 Principal (800) 547-7754
LegalShield Group No: 47422 Legal Shield (800) 654-7757
About this Booklet. This benefit summary provides selected highlights of the SLFHC (the “Company”) employee benefits program. It is not a legal document and
shall not be construed as a guarantee of benefits nor of continued employment at the Company. All benefit plans are governed by master policies, contracts and
plan documents. Any discrepancies between any information provided through this summary and the actual terms of the policies, contracts and plan documents are
governed by the terms of these policies, contracts and plan documents. The Company reserves the right to amend, suspend or terminate any benefit plan, in whole or
in part, at any time. The Plan Administrator has the authority to make these changes. CBIZ Benefits & Insurance Services, Inc.
1765 East Skyline Drive • Tucson, AZ 85718
520.327.6421 FINAL OCT. 2016
Important Employer Notices continued