Contact

• Care Guidance Program		855.MMC.WELL (855.662.9355)	mmccareguidance@montefiore.org
  Claims Administrator/Medical MonteCare EPO MonteCare PPO MontePrime EPO (House Staff) Registered Nurses Health Plan	Empire BlueCross BlueShield	866.236.6748	www.empireblue.com/montefiore
  	24/7 NurseLine	877.TALK.2RN (877.825.5276)
  	Empire Getting Better Care		www.empireblue.com/getting-better-care
  	BlueCard Worldwide® Program		www.bluecardworldwide.com
  Claims Administrator/Dental Preventive & Diagnostic Care Cigna DPPO Dental Plan Cigna DHMO Registered Nurses Dental Benefits	Cigna	800.Cigna24 (800.244.6224)	www.cigna.com DHMO Directory CT  – Network – Specialist NJ  – Network – Specialist NY  – Network – Specialist DPPO Directory CT  – Network NJ  – Network NY  – Network
  COBRA	WageWorks Mail Election forms to P.O. Box 226101, Dallas TX  75222 Mail checks to PO Box 660212, Dallas TX  75266-0212	888.678.4881	mybenefits.wageworks.com
  Conifer Value Based Care		855.381.3441
  Employee Assistance Program (EAP)		844.300.6072	www.myliferesource.com Your website access code is C4NKN.
  Montefiore Provider Network	CMO Customer Service Department	914.377.4400	MonteCare/MontePrime Provider Directory RN Provider Network Retiree Provider Network
  Prescription Drug Program	Montefiore Outpatient Pharmacy	718.920.4937	www.montefiore.org/montefiorepharmacy
  	Express Scripts	800.631.7780	www.express-scripts.com
  Vision	Spectera Vision Plan	800.638.3120 800.847.4663	www.myspectera.com www.visiondirect.com Laser Vision Network of America

   

Contact

• 1199 Benefit and Pension Fund		646.473.9200	www.1199seiubenefits.org
  Health Services Retirement Plan (HSRP)		212.956.8340	Notice to Interested Parties
  Local 30 International Union of Operating Engineers		718.847.8484	www.iuoelocal30.com
  NYSNA Pension		877.RN.BENEFITS 877.762.3633 800.342.4324 518.869.9501	www.rnbenefits.org
  Special & Superior Officers Benevolent Association	199 North Wellwood Avenue Lindehurst, NY 11757	631.587.9116	ssoba.com
  Teamsters Local 445	15 Stone Castle Road Rock Tavern, NY 12575	845.564.4076	teamsterslocal445.org
  Montefiore Medical Center 403(b) Plan	Fidelity	800.343.0860	www.netbenefits.com/atwork

   

Contact

• WageWorks

  877.924.3967

  www.wageworks.com

   

Contact

• MetLife Legal Plans

  800.821.6400

  www.legalplans.com Password: 3700010/family coverage 3710010/single coverage

   

   

Contact

• Disability	Central Leave Office	914.349.8528	centralleaveoffice@montefiore.org
  Life and AD&D Insurance	Securian	844.878.2198	LifeBenefits.com
  STD, LTD and Buy-Up LTD	Principal Life®	800.245.1522	www.principal.com
  LTD – Contributory RNs – 1199	For pending claims Prudential Disability Claims	860.842.1718	reference policy number 44416
  	Pending EOI application Medical Underwriting Team	888.257.0412

   

Contact

• Tuition Reimbursement

  914.349.8563

  tuition@montefiore.org

   

Contact

• Commuter Benefits	WageWorks	877.924.3967	www.wageworks.com
  511NY Rideshare	Out-of-state (888.465.1169)	511	www.511ny.org/rideshare
  Employee Discounts	Corporate Offers	212.203.1818	www.corporateoffers.com
  	PerksConnect	877.253.7100	montefiore.perksconnection.com Group Code: MontefioreMC
  	Nationwide Pet Insurance	877.738.7874	www.petsnationwide.com
  	Plum Benefits	212.660.1888	www.plumbenefits.com
  	Wireless Discounts
  	T-Mobile	855-570-9947
  	Verizon		www.verizon.com/verizonconnections
  Special Promotions	Auto/Homeowner Insurance
  	MetLife	800.438.6388	www.metlife.com
  	Travelers	888.695.4640	www.travelers.com
  	LASIK Surgery	718.920.2020
  	Municipal Credit Union	212.693.4900	www.nymcu.org
  	Purchasing Power	800.537.3134	www.montefiore.purchasingpower.com
  Voluntary Insurance Program (VIP)	Critical Illness Insurance Integrated Disability Benefit Income Protection – 1199 Personal Accident Insurance Universal Life Insurance Whole Life Insurance	866.936.7011	www.mymmcbenefits.com
  Individual Disability Income (DI) Insurance	Principal	212.536.6181	rgoodman@lenoxadvisors.com

   

Forms

• Empire Medical Claim Form Medco Prescription Drug Claim Form Medco Prescription Drug Mail Order Form Cigna Dental Claim Form

   

Forms

• WageWorks PayMeBack Healthcare Form WageWorks PayMeBack Dependent Care Form WageWorks Letter of Medical Necessity

   

Forms

• Notification of Start and Return from Disability Securian Beneficiary Designation Form Disability Comparison Voluntary LTD Enrollment Card Voluntary LTD EOI Form

   

Forms

• Montefiore Medical Center Tuition Reimbursement V-18 Tuition Reimbursement Tuition Reimbursement Application Process Tuition Reimbursement Application Service Commitment Agreement – RN (NYSNA) CME PA Application Process CME PA Reimbursement Application CME PT Application Process CME PT Reimbursement Application

  Montefiore Medical Center Scholarship Program V-21 Scholarship Program for Children of Associates College Scholarship Program for Children of Montefiore Associates Scholarship Application Process Montefiore Medical Center Scholarship Reimbursement – Doctor, Executive, Scientist V-20 Tuition Reimbursement Tuition Reimbursement Application Process Tuition Reimbursement Application

   

   

Legal

• Notices	Children’s Health Insurance Program (CHIP) Claiming Healthcare Benefits Consolidated Omnibus Budget Reconciliation Act (COBRA) Family and Medical Leave Act (FMLA) Marketplace Notice Medicare Part D Notice Newborns’ and Mothers’ Health Protection Montefiore Non-Discrimination Notice Group Health Plan Covered Entity Grievance Policy Notice of Privacy Practices Paid Family Leave Paid Family Leave and the Family Medical Leave Act Claiming PFL Benefits PFL Frequently Asked Questions Umbrella PHI Privacy & Security Policy Uniform Services Employment and Re-Employment Rights Act of 1994 (USERRA) Women’s Health and Cancer Rights (WHCRA)
  Summary of Benefits & Coverage (SBC)	MonteCare Basic EPO SBC MonteCare EPO SBC MonteCare PPO SBC MontePrime EPO SBC Registered Nurses Health Plan SBC
  Summary Plan Description (SPD)	​Associate Benefits Program SPD Security Guards SSOBA SPD Teamsters Benefits Program House Staff Benefits Program SPD RN (NYSNA) Benefits Program SPD MonteCare Basic EPO SPD

   

Legal

• Montefiore Medical Center 403(b) Plan SPD HSRP SPD

   

Legal

• Summary Plan Description (SPD)

  Associate Benefits Program SPD Security Guards (SSOBA) SPD House Staff Benefits Program SPD Teamsters Benefits Program SPD RN (NYSNA) Benefits Program SPD Healthcare Flexible Spending Account SPD (RN - 1199)

   

Legal

• Summary Plan Description (SPD)

  Associate Benefits Program SPD Security Guards (SSOBA) SPD House Staff Benefits Program SPD Teamsters Benefits Program SPD

   

Legal

• Insurance Certificates	Montefiore Medical Center	Disability Benefits – Statement of Rights STD - All Other Members STD - Eligible Registered Nurses STD - Executive Members Accidental Death & Dismemberment Insurance Certificate AD&D SPD Business Travel Accident SPD Travel Assistance Certificate Life Insurance Certificate LTD Grandfathered Sr Mgrs LTD Certificate Rider - Grandfathered Sr Mgrs LTD NUC LTD Certificate Rider - NUC LTD Sr Mgmt LTD Certificate Rider - Sr Mgmt LTD RN LTD Certificate Rider - All Members
  	Montefiore Mount Vernon Hospital Montefiore New Rochelle Hospital Schaffer Extended Care Center	Accidental Death & Dismemberment Insurance Certificate AD&D SPD Life Insurance Certificate MMV BTA SPD MMV Travel Assistance MNR BTA SPD MNR Travel Assistance SECC BTA SPD SECC Travel Assistance

   

Legal

Tools

• Medical	MonteCare/MontePrime Provider Directory MonteCare/MontePrime Mental Health Provider Directory Empire BlueCard PPO Network RN Provider Network Retiree Provider Network Empire BC BS − Blue National Doctor and Hospital Finder Apps
  Prescription Drug	Express Scripts National Preferred Formulary and Exclusions Specialty Medication List
  Dental	Cigna Enhanced DPPO Benefit Summary Cigna DPPO Benefit Summary Cigna Preventive & Diagnostic Benefit Summary Cigna DHMO Benefit Summary Cigna RN Dental Benefit Summary Cigna Retiree Dental Benefit Summary Find a Montefiore Dentist Find a Cigna Dentist

   

Tools

• WageWorks Healthcare FSA Calculator WageWorks Dependent Care FSA Calculator www.fsaworks4me.com Medical & Dental Expenses IRS Publication 502 Child & Dependent Care Expenses IRS Publication 503 WageWorks® Healthcare Card

   

Tools

• An Employee’s Guide to Health Benefits Under COBRA Social Security Disability Benefits Financial Planning Calculator – Covering Shortfalls Due to Disability www.disability.gov

   

Tools

Tools

• Commuter Benefits

  WageWorks Commuter Benefits Calculator WageWorks4Me WageWorks PayMeBack Commuter Form Carpooling Tips and FAQs WageWorks Commuter Card