Student Certification Information

Please be aware that if you have a student between the ages of 19 and 24, you will be receiving a Student Certification form from Highmark Blue Shield in mid-July. It is very important that you complete this form and mail it back to Highmark by September 1, 2009, in order to avoid disruption of your student’s coverage.

This year, the student certification process will be streamlined to include medical, dental and vision; you will no longer need to complete separate certification forms for each benefit. For those enrolled in the Dental Benefit ONLY, the Student Certification form will come from United Concordia.

If you have any questions regarding the form or the process, please call Highmark Blue Shield’s dedicated customer service unit for Penn State at 800-914-4384.

BENEFITS ELIGIBILITY

1. Health Plan
2. Medicare Creditable Coverage Certificate

BENEFIT FORMS

1. AD&D Conversion Form (PDF)
2. AD&D and Life Claim Form (PDF)
3. AD&D Permanent Total Disability Claim Form (PDF)
4. Beneficiary form - AD&D (PDF)
5. Beneficiary Form - Life Insurance (PDF)
6. Beneficiary Form (SERS) (PDF)
7. Beneficiary Form - TIAA-CREF
8. BlueCard Worldwide Brochure (PDF)
9. Choose or Change Benefits (ESSIC)
10. COBRA Election Form for Continuation of Benefits 2009 (PDF)
11. Dental Claim Form (PDF)
12. Flexible Benefits Election Form
13. Flexible Benefits Request for Reimbursement (PDF)
14. Flexible Benefits Request for Reimbursement Interactive Form
15. Grant-In-Aid Form - Penn State University (PDF)
16. Grant-In-Aid Form - Pennsylvania College of Technology (PDF)
17. Highmark Medical Claim Form (PDF)
18. Highmark Prescription Reimbursement Form (PDF)
19. International Claim Form BlueCard Worldwide (PDF)
20. Life Insurance Enrollment/Change Form (w/ Evidence of Good Health) (PDF)
21. Long Term Disability Conversion Form (PDF)
22. Long-Term Disability Enrollment Form/Health Statement (PDF)
23. Maintenance Prescription Drug Plan (MPDP) Enrollment Form (University Health Services Pharmacy)
24. Medco by Mail (PDF)
25. Prudential Life Insurance Conversion Application (PDF)
26. Retirement Plan Selection for Part-Time Employees (PDF)
27. Sickness and Accident Supplement (SAS) Claim Form
28. TIAA-CREF Application - Retirement Plan
29. TIAA-CREF Deferred Compensation [457(b)] Application
30. TIAA-CREF Group Supplemental Retirement Annuity (GSRA) Application
31. Highmark Blue Shield Vision Claim Form (PDF)
32. Voluntary Salary Reduction Agreement (PDF)

DENTAL CARE COVERAGE

1. Dental Care Coverage
2. Basic Dental Plan Certificate of Coverage (PDF)

EDUCATION BENEFITS

1. Educational Privileges
2. nowU Guaranteed Savings Plan (529 plan)

EMPLOYEE ASSISTANCE PROGRAM (EAP)

1. Employee Assistance Program (EAP)

FLEXIBLE BENEFITS

1. Flexible Benefits
2. Flexible Benefits FAQs
3. Flexible Benefit Summary Plan Description (PDF)

HEALTH PLAN

1. 2009 Health Plan
2. 2009 Prescription Drug Coverage
3. 2009 Highmark Blue Shield PPOBlue Benefit Booklet
4. IMPORTANT – Routine Testing Coverage (PDF)
5. Centre County Health Initiative $100 Copayment
6. Centre County Health Initiative - Zip Codes
7. Continuing Benefits with COBRA
8. Dependents Turning Age 19
9. How to Read Your PPOBlue Explanation of Benefits Form
10. Map to State College Highmark Office
11. Same-Day Acute Care Clinic at Penn State Family Medicine
12. Specialty Medications

LIFE INSURANCE

1. Group Life Insurance
2. Group Life Insurance Booklet - Age-Graded Plan
3. Group Life Insurance Booklet - Level Option Plan (for information only)
4. Life Insurance Beneficiary
5. Life Insurance Summary Plan Document (PDF)

LONG-TERM DISABILITY (LTD) AND ANNUITY PREMIUM BENEFIT (APB)

1. Long Term Disability (LTD) and Annuity Premium Benefit (APB)
2. LTD And APB Summary Plan Document (PDF)
3. LTD AND APB Amendment #1 (PDF)

PRIVACY INFORMATION

1. Health Plan Notice of Privacy Practices Effective: 1/1/03
2. Privacy Information

PROGRAMS

1. Health Matters
2. Human Resource Development Center

RETIREE BENEFITS

1. 2009 Retiree Contributions
2. 2009 Retiree Contribution Information for Retirees Who Were Retired & Age 70 Prior to 1/1/07
3. Map to State College Highmark Office
4. Retiree Benefits
5. 2009 Retiree Medical Benefits
6. 2009 New Davis Vision Discount Program
7. How To Find a Davis Vision Provider

RETIREMENT PLANS

1. Retirement Plan Comparisons
2. Retirement Plan Frequently Asked Questions
3. Selecting a Retirement Plan

SUPPLEMENTAL RETIREMENT PLANS

1. Summary of Supplemental Retirement Plans
2. Introduction to Roth 403(b)

VISION CARE COVERAGE

1. Vision Care Coverage
2. How To Find a Highmark Blue Shield Vision Provider

ACCIDENTAL DEATH AND DISMEMBERMENT

1. Accidental Death and Dismemberment Insurance (AD&D)
2. Penn State University AD&D Booklet (PDF)
3. Penn State University AD&D Policy (PDF)