Benefit Compliance
Employee Welfare Benefits Plan
The Welfare Benefits Plan Summary Plan Description [pdf] describes the benefits to which you may be entitled under the plan, your rights, and responsibilities. This document and the certificates of insurance for its underlying benefits are intended to inform eligible employees about the plan's terms and their rights under it. The specific benefits offered under the plan are:
- Summary of Material Modification - COVID [pdf]
- Welfare Benefits Plan Summary Annual Report [pdf]
- Flexible Benefits Program and Pre-Tax Premium Benefits Program [pdf]
- Voluntary Accidental Death and Dismemberment Insurance [pdf]
- Employee Assistance Program [pdf]
- Dependent Eligibility Summary [pdf]
Required Notices
The documents and notices below are provided to you in accordance with regulatory requirements that govern employer-sponsored benefit plans. They are intended to provide you with basic information concerning JAVĿ¼’s benefit plans and your rights under them. You have the right to request and obtain a paper version of any of these documents free of charge. If you have questions regarding benefits plan communications or if you would like to request paper copies of these documents, contact JAVĿ¼’s HR department at (585) 385-8048 or by email at humanresources@sjf.edu.
- 403(b) Plan Universal Availability Notice [pdf]
- Transparency in Coverage Notice [pdf]
- Notice of Family Medical Leave Act Rights, see Employee Handbook [pdf]
- HIPAA Notice of Privacy Practices [pdf]
- HIPAA Notice of Privacy Practices Reminder [pdf]
- HIPAA Special Enrollment Notice (Qualifying Life Events) [pdf]
- Newborns' and Mothers' Health Protection Act [pdf]
- Notice of Health Insurance Exchange [pdf]
- Notice of Creditable Prescription Drug Coverage [pdf]
- Blue EPO Plan Summary [pdf]
- SimplyBlue Hybrid Plan Summary [pdf]
- Blue HDHP Plan Summary [pdf]
- Women's Health and Cancer Rights Act [pdf]
Note: Annual ACA 1095-C forms are available through the benefits enrollment portal on the Employee File page.
Group Life & Disability Insurance - Summary of Benefits
- Life and Accidental Death & Dismemberment [pdf]
- Long Term Disability [pdf]
- Short Term Disability [pdf]
*These contracts represent the benefits at the time that they are issued to JAVĿ¼. They are not to be relied upon as the official description of the benefits and Excellus Health Plan, Inc. will not routinely update them. Individual employees should refer to their actual contracts and the Excellus Customer Service Department with questions, using the telephone number listed on their Excellus BlueCross BlueShield ID cards.
Retirement Plan
The Retirement Plan Summary Plan Description [pdf] document describes the benefits to which you may be entitled under the plan, your rights, and your responsibilities. This document plus the summaries made available by the institutions sponsoring investment funds under the plan are intended to serve as a summary plan description to inform eligible employees about the plan's terms and their rights under it.