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Health Forms and Resources

Benefits Guide

Medical - BlueCross BlueShield of Texas
$1,000/$2,000 Deductible Summary Plan Description
$2,600 Deductible PPO with HSA Summary Plan Description
$5,000 Deductible PPO with HSA Summary Plan Description
Medical Claim Form
Prescription - Prime Therapeutics
Prescription Drug Claim Form
PrimeMail Refill Form
PrimeMail New Prescription Fax Order Form
PrimeMail Pharmacy Order Form
Dental - BlueCross BlueShield of Texas
Benefits Highlights
Claim Form
Summary Plan Description
Student Certification
Vision - VSP
Benefits Summary
Out-of-Network Claim Form
Flexible Spending Accounts - Discovery Benefits
Automatic Dependent Care Request Form
Automatic Orthodontia Request Form
Direct Deposit Enrollment/Change Form
Reimbursement Request Form
Instructions: Request a Debit Card Online
Medical Necessity Form
Receipt and Substantiation Form
Health Savings Account - BenefitWallet
Debit Card FAQ
Deposit Slip
Fee Summary
Investment Platform
Life and Disability Insurance - The Standard
Beneficiary Designation Form
Long-Term Care - CNA
Detailed Plan Information Booklet
Rates-Parents, etc.
Leave of Absence
Family Medical Leave Act - Certification for Dependents
Family Medical Leave Act - Certification of Health Provider
Leave of Absence Form - Staff


Retirement Forms and Resources

403(b) Retirement Plan
Qualified Default Investment Alternative (QDIA) Notice
Understanding the SMU 403(b) Retirement Plan
Emeriti ADV Privacy Notice
Emeriti Frequently Asked Questions
Medicare and You 2015
Retiring From SMU
Retiring From SMU - 2015
How SMU's Medical Plans Work With Medicare
SMU Retiree Medical Eligibility
Social Security
How Social Security Benefits are Calculated
Understanding the Benefits



Change of Name Form
COBRA Benefits Guide
COBRA Benefits Highlights
Dissolution of Domestic Partnership
Statement of Domestic Partnership
Termination Form