Employee Benefit and Contact Information

Secure Form Portal- Upload

Please use this form portal to safely and securely upload any benefit, new hire, banking, etc. documents you need to submit to the Employee Engagement Office: Secure Form Portal 

*Click on the PDF fillable form link you wish to submit to the secure portal for processing, select download or save as (right click your mouse) and save this form to a folder on your computer.  Once the form is saved/downloaded on your computer, close the form.  Open the form you saved on your computer, complete the form and save it again.

Once you upload your form via the portal, please email the hr@daemen.edu to let us know the form has been submitted. 

Univera Healthcare

www.univerahealthcare.com

Service line is 800-499-1275 

Univera offers two plans:

1. Univera Signature CoPay1 plan (replacing the BC/BS POS 206 and PPO 815 plans) and;
2. Univera Signature Deductible 3 (replacing BC/BS POS 8200).

• Univera Health Insurance Enrollment Form (Fillable PDF)
• • ​​​​You are not required to complete ALL sections of the Univera Application.  Please see notes below regarding which sections you must complete:
  • Section 1:
    • Select your Medical Plan:  CoPay 1 or Deductible 3
    • Select your coverage level: Self Only/Self & Child/Self & Spouse or Domestic Partner/Family
  • ​Section 2:
    • Complete all personal information in this section, Name, Address, Phone, DOB (xx/xx/xx), SS#
    • Complete the questions regarding Medicare or date of retirement if it pertains to you
  • Section 3:
    • Select reason for change:  Open Enrollment
  • Section 4:
    • Skip
  • Section 5:
    • Complete information about your dependents you are seeking to add to the plan (if any)
  • Section 6:
    • Only complete if you have other medical coverage.  You do not need to complete if you have other dental coverage.
  • Section 7:
    • Type your name on the signature line and date

• Univera PPO Signature Copay 1 Summary​
• Univera PPO Signature Deductible 3 Summary
• Univera  Plan Details 
• Pharmacy Formulary
  • The Drug List that should be used is – 3-Tier Formulary https://provider.univerahealthcare.com/policies/prescriptions/formularies
• Prescription Drug Coverage Flyer

How to find Doctors & Facilities:

https://www.univerahealthcare.com/find-a-doctor/provider

1. Click on the Start Search under the I’m a Guest section.
2. Once on the next page, in the upper right corner click on the ALL PLANs button.
3. Click on Find a different plan
4. Click on Univera PPO/PPO HSA and Signature PPO  

Wellness Information:

• $250/$500 Wellness Your Way Card
• HealthyU - Wellness Screenings
• Univera - Perks 4 U Discounts

Tools & Resources:

• Mobile App
• Online Resources
• Making the Most of Your Health Plan Webinars

Mail Order Prescriptions:

• Mail Order Prescriptions Information 
• Express Scripts Mail Order Form
• Wegmans Home Delivery Form

Nationwide Network Benefits:

Are you or a dependent going to be out of the WNY area for school or travel?  Univera Can Help You Find The Provider Of Your Choice Call 1 (800) 678-7427 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Standard Time) and identify yourself as a Univera Healthcare member accessing the PHCS Healthy Directions and MultiPlan Networks.

You may also contact Patricia Brooker directly at patricia.brooker@univerahealthcare.com.

• Multiplan Brochure

Telemedicine:

• Telemedicine- MD Live
• Telemedicine - Behavioral Health Info
• Telemedicine- Text to Register

Dental Insurance 

MetLife Website: http://www.metlife.com/mybenefits

Please click on the link below to find a participating dentist near you.  Use the PDP Plus Option: https://www.metlife.com/

Customer Service: (800) GET-MET8  or (800) 438-6388 ~ Reps are available 8 am - 11 pm EST

The dental insurance will be available through Metlife Insurance. This is an insurance plan that provides group-plan discounts but it is an optional program. Coverage for major dental services and orthodontia for children under the age of 19 is included in the plan. There is a modest cost to employees for this benefit. 

*Employees who are enrolled in the dental plan through MetLife do receive a 20% discount on vision. The discount is an added benefit to the dental coverage.

If you are not making any changes to your Dental  benefits, you are not required to complete a new enrollment form.

• MetLife Dental Enrollment Form (Fillable PDF)​
• MetLife Dental Benefit Summary 
• MetLife - How to Use Your Dental Plan
• Find a Dental Provider 
• MetLife- Vision Access Discount Program

Health Savings Accounts (HSA)

LakeShore Savings HSA (effective 6/1/2020)

Customer Service- Snyder branch phone number (716)898-2101

 www.lakeshoresavings.com 

The HSA Provider for 2020-2021 will be Lakeshore Savings Bank.  All participants in the Univera Signature Deductible 3 Plan are required to complete an application to open a new account for Health Savings in order to receive the employer contribution ($1500 /$3000) in June. 

You will have the option to keep your existing balance with Health Equity or roll it over into your new account with Lakeshore Savings. 

*Please note, there is a monthly administration fee of $3.95/month if you choose to keep your funds in your Health Equity Account. This monthly administrative fee is waived if employees maintain a $2500 balance over the course of that month. If you elect to roll your funds over into Lakeshore, there is a $25 account closure fee with Health Equity.​

​1.       All employees enrolled in the Signature Deductible 3 plan are REQUIRED to open a new HSA account with with Lakeshore Savings to receive the employer contribution ($1500/$3000):

The following forms must be completed in full to create and open an HSA account with Lakeshore. 

• HSA Customer Verification Form (Fillable PDF)
• W-9 Form (TIN Certification for HSA) (Fillable PDF)
• ATM - Debit Card Request (HSA) (Fillable PDF)
• State's Driver's License or US Passport
  • In order to open an account at Lake Shore Savings for the HSA and comply with the USA Patriot Act, employees will need to provide a copy of their state’s driver’s license or US passport. This is standard practice for all banks.  Employees will need to provide a copy of their spouse’s driver’s license if planning of having a spouse as an authorized user/signer.

Sign up for Online Banking!

• Direct Link: https://web1.secureinternetbank.com/PBI_PBI1151/login/222371656
• Please select 'Checking' Account when signing up.
• You will need your account number in order to sign up. Please call Lakeshore Savings Customer service number at 716-898-2101 for assistance in obtaining this information.

2.       If I choose to transfer my current HSA account  balance at  Health Equity to my new account with Lakeshore Savings, what do I need to do?

You must complete an HSA Transfer Request form:

• HSA Transfer Request Form (Fillable PDF)
  • ​​This form will ask for the Health Equity Address and their account number.
    • The Health Equity address is: Health Equity 15 W Scenic Pointe Dr. Ste 100 Draper, UT 84020
    • Your  HSA account number can be found on your Health Equity portal next to your name.
    • If employees choose to transfer their account balance to Lakeshore (​Health Equity Account Closure Form), they should request a check made out to - Lake Shore Savings Bank as the custodian for "Name". 

3.       If I choose to have additional HSA funds taken out as payroll deductions (pre-taxed), what do I need to complete?

• Employee HSA payroll deduction form (Fillable PDF)

DISCLOSURES:

• HSA Disclosure Statement
• HSA 3505C
• Privacy Disclosure
• Tax Favored Account (TFA) Account Agreement
• Truth-In Savings- HSA information
• Funds Availability Policy
• HSA Information
• CARES ACT- HSA Supplement Updates
• HSA Accounts and Medicare

Flexible Spending Accounts (FSA)

Pro-Flex Administrators LLC (effective 6/1/2020)

https://proflextpa.com/

Customer service- local number is 716-633-2073. ProFlex Fax #  716-929-2013​

The new FSA provider for 2020-2021 will be ProFlex.  If you are enrolling in the Univera Signature Copay 1 Plan and want to participate in a Flexible Spending Account, you will be required to complete a ProFlex enrollment application.​

DOCUMENTS & FORMS:

• FSA ProFlex Enrollment Form (Fillable PDF)
• FSA DC Plan Document​
• https://proflextpa.com/participant-information/
• ProFlex FSA Information for Enrollment
• Direct Deposit- Healthcare Claim Reimbursement Information
• FAQs for FSA

Life Insurance 

• Lincoln Life Insurance Enrollment Form (Fillable PDF)
• Lincoln Life Insurance Beneficiary Form  (Fillable PDF)
• Lincoln Supplemental Life Insurance Summary 
• Lincoln Privacy Policy

Lincoln Website: http://www.LincolnFinancial.com

Phone: (800) 423-2765

Retirement Plan

TIAA

Your Online Security Is Priority

http://www1.tiaa-cref.org/tcm/daemen

Investment Options:​ https://www.tiaa.org/public/tcm/daemen/view-all-investments

CARES Act: https://www.tiaa.org/public/learn/prepare-unexpected/guiding-you-through-turbulent-times/cares-act

PHONE NUMBERS:

Local Branch Office: (716) 862-5910
General Inquiries: (800) 842-2733e
Rates of Return, Allocation Changes, CREF transfers: (800) 842-2252

DOCUMENTS & FORMS:

• Retirement Contribution Enrollment/Salary Reduction Form (Fillable PDF)
• TIAA Online Enrollment Instructions 
• Summary Plan Description- Retirement 
• HEART Summary Material Modifications 
• Roth Contribution Option 
• TIAA Security Authentication 
• Summary/Annual Report 7/1/18 - 6/30/19

PLAN DISCLOSURES

• TIAA Plan Fee Disclosure 3-21-2020
• 403(b) Retirement Plan​ Notice of Universal Availability
• January 2020 Plan and Investment Notice
• May 2020 Qualified Default Investment Alternative (QDIA) Annual Notice - Daemen Retirement Plan
• May 2020 Qualified Default Investment Alternative (QDIA) Annual Notice - Tax Deferred Annuity Plan
• 2019 TIAA-CREF Fee Disclosure (Defined Contribution) 
• 2019 TIAA-CREF Fee Disclosure (Supplemental) ​​

Vision Insurance 

*Employees who are enrolled in the dental plan through MetLife do receive a 20% discount on vision. The discount is an added benefit to the dental coverage.​

• MetLife- Vision Access Discount Program

The college offers vision care insurance through VSP or Davis Vision which is administered by Guardian Life Insurance. This is an optional insurance program to which the college does not make contributions, but it is offered at a group-rate discount on premiums. There will be no increase in the cost of premiums in 2020.​

https://www.guardiananytime.com   Customer Service: (800) 541-7846

• Guardian Vision Enrollment Form (Fillable PDF)​
  • On page 2 of the Guardian Vision form, Option 1 is VSP and Option 2 is Davis.
• VSP and Davis Vision Side by Side 
• Comparing VSP Choice with Davis Vision Designer
• Guardian Vision Benefits Summary
• The difference in the vision plans is really in the network of providers.  You can do a search of both networks and see which one your provider is in.  VSP is more of the independent vision providers and Davis more of the “big box” stores.  The website is www.guardiananytime.com

Employee Assistance Program

EAP administered through Lincoln and ComPsych 

Connect to a counselor for free support services, 24 hours a day, 7 days a week (for employees and family members): (888) 628-4824

Visit www.Lincoln4Benefits.com or www.GuidanceResources.com

Username: LFGsupport
Password: LFGsupport1

• EmployeeConnect Informational Flyer 

Business Travel Accident Insurance  (H3)

CHUBB Business Travel Insurance: www.acetravelassistance.com​

PHONE NUMBERS:
U.S or Canada Locations: 1 (800) 243-6124
International Locations: +1 (202) 659-7803

Identity Theft Protection: 1(866) 299-7277

DOCUMENTS & FORMS:

• CHUBB Business Travel Accident Insurance Program
• Travel & Medical Assistant Provider- Europ Assistance
• CHUBB Identify Theft Protection

Daemen Tuition Waiver Program

Full time employees are eligible for 100% tuition waiver for undergraduate classes at Daemen College the semester after hire.This benefit is also available to the employee's spouse/same sex domestic partner and dependent children.

100% tuition waiver for graduate level courses at Daemen College are available to full time employees and their spouse/same sex domestic partner. Dependent children of the employee are eligible for a 50% tuition waiver.

• Daemen Tuition Benefits Explanation - How to Apply 
• Application for Daemen College Tuition Waiver 
• Employee Job-Related Verification Form (Graduate Programs)

Tuition Exchange Scholarship Program (TE)

Tuition Exchange (TE) is a reciprocal scholarship opportunity for dependent children of full time employees after five years of service. Tuition Exchange is not an employee benefit nor is it a guaranteed scholarship opportunity. There are over 500 colleges and universities nationwide participating in the Tuition Exchange Program and scholarships are competitive. 

• Preliminary Application for Tuition Exchange 
• Tuition Exchange Export Policy
• Tuition Exchange Participating Institutions

If you have questions, contact the Tuition Exchange headquarters at (301)-947-1827, or visit their website: https://www.tuitionexchange.org

CIC Tuition Exchange

The Council of Independent Colleges Tuition Exchange Program (CIC-TEP)  is available to eligible full time employees and their dependents as defined by IRS regulations to apply for tuition benefits at a CIC participating school. CIC participating schools include over 400 schools nationwide. Charges covered by tuition remission are determined by the host institution, but generally cover full tuition. This benefit is available the semester after hire and covers undergraduate courses only.

• CIC Tuition Exchange Student Application
• CIC Tuition Exchange Guide
• CIC Tuition Exchange Program Participating Institutions 

For more information, visit the CIC Website : https://www.cic.edu/member-services/tuition-exchange-program

If you have questions, contact the CIC director of membership services, at (202)-466-7230 or tep@cic.nche.edu

Employee Discounts

Airport Parking- The Parking Spot
Parking-Spot-Info-2020

AT&T Wireless
Monthly plan discounts available.
Local Office: 1730 Niagara Falls Blvd Suite 400

Amherst Federal Credit Union
http://www.amherstcu.org
(716) 634-3881

EnergyMark, LLC
http://www.energymarkllc.com/
(716) 632-1800

• Informational Flyer

iRepair Buffalo
http://www.irepairbuffalo.com
(716) 276-3219

Lakeshore Savings Bank

• Open an Account Online 
• Checking Accounts ​
• Lake Shore Savings Promotion: LS Plus Checking Account​

Liberty Mutual Home, Auto, Life Insurance
http://www.libertymutual.com/insurance-office-wheatfield-ny
(716) 730-4906

Regal Cinemas
Premiere Movie Passes are available for purchase at the discounted price of $9.00/ea in the HR Office. These tickets are valid for all films and showtimes, though surcharge fees may apply to IMAX, RPX, Large Format and 3D films.  Passes do not expire.

Sprint Wireless

• Sprint Deals 

Additional Resources

Social Security Administration

http://www.ssa.gov

PHONE NUMBERS:
General: (800) 772-1213
TTY: (800) 325-0778

LOCAL OFFICES:

186 Exchange Street
Suite 100
Buffalo, NY 14204

1900 Ridge Road
Suite 120
West Seneca, NY 14224

FMLA (Family Medical Leave Act):

The FMLA allows eligible employees to take up to 12 work weeks of unpaid leave during any 12-month period to care for a new child, care for a seriously ill family member, or recover from a serious illness. In order to be eligible for FMLA leave, an employee must have worked for the employer for at least 12 months, have worked at least 1,250 hours over the past 12 months, and work for an employer with at least fifty employees. FMLA is to be taken concurrently with Short Term Disability, Paid Family Leave, etc.

• Certification of Health Care Provider for Employee's Serious Health Condition (FMLA)​
• Certification of Health Care Provider for Family Member's Serious Health Condition (FMLA)​

NYS PFL (Paid Family Leave Act):

The NYS Paid Family Leave Act allows employees who have worked 26 consecutive weeks as a full-time employee, or 175 days as a part-time employee over a 52 week period to be eligible for paid leave.  This law covers new parents, family caregivers and military families with active duty deployment.  Employees may be eligible to get paid time off for the following reasons:

• to bond with a newly-born, adopted or foster child;
• to care for a close relative with a serious health condition; or
• to assist when a family member is deployed abroad on active military service.

The law provides full job protection and continuation of health insurance coverage while you are on paid leave, however, you will be responsible for any premium payments you regularly make. Employees and employers are subject to a small payroll tax that funds this benefit, much like NYS Disability.  See the chart below for details on the weeks of leave and benefit.  You can take your Paid Family Leave all at one time or you can take it one day at a time, as needed. 

• Daemen College NYSPFL Policy​
• NYSPFL Employee Fact Sheet
• NYSPFL Parent-Child Bonding Application
• NYSPFL Care for Family Member Application
• NYSPFL Military Application

Disability (DBL) Coverage (Short & Long Term):

• Disability Claim Form - Lincoln Financial
• Statement of Rights- NYS Disability Benefits
• DBL Employee Guide

NYS Short Term Disability

NYS disability benefits cover temporary and long term medical conditions that prevent you from working and earning an income.  Disability benefits will pay up to 50% of your weekly income, but has a cap of $170 per week.  Benefits begin on your eighth consecutive day out of work; the first 7 days is an unpaid waiting period. To supplement the income gap of the waiting week, hourly employees are able to use PTO and/or a combination of vacation time; salaried employees must use vacation time.

Salary Continuation

Through Daemen College, eligible employees are entitled to the benefit of 100% salary continuation during incapacitation within the 90 day guideline. Salary continuation is not to be granted until all necessary paperwork has been received by the Employee Engagement Department. Employee’s are eligible to maintain their benefits during their period of incapacitation during Short Term Disability.

Long Term Disability

Daemen provides a Long Term Disability Benefit to all full time employees who work 30 hours or more per week.  This Plan is administered by Lincoln Financial and provides a replacement salary of 2/3 for the length of disability or normal retirement age, whichever is less.  There is a 90 day elimination period before this benefit begins.