Product Resources
The Resources You Need,
Just a Click Away
Medical
- Customer Service: 888-219.5122
- Participant/Employee Portal
- Healthcare Bluebook
- NavCare Flyer
- CIGNA Provider Directory
- CIGNA Payer ID: 62308
- CIGNA Claims Submission: PO Box 188061, Chattanooga, TN 37422-8061
2024 Effective Dates
Dental
Dental Overview
- Small Group (2-50) & Voluntary Dental Brochure with Rates
- Large Group (50+) & Voluntary Dental Brochure with Rates
Dental Rewards
The voluntary Passive PPO 100%/80%/50%-$1,000 and the voluntary Passive PPO 100%/80%/50%-$1,500 with Ortho dental plans include a valuable feature that allows qualifying plan members to carryover part of their unused annual maximum.
- Dental Rewards — Passive PPO 100%/80%/50%-$1,000 [PDF]
- Dental Rewards — Passive PPO 100%/80%/50%-$1,500 [PDF]
Group Dental
Voluntary Dental
- Passive PPO 100%/80%/0%-$750
- Passive PPO 100%/50%/50%-$750
- Active PPO 100%/80%/50%-$1,000
- Passive PPO 100%/80%/50%-$1,000
- Passive PPO 100%/80%/50%-$1,500 with ortho
- What’s the difference between a “passive” and “active” dental PPO?
CBIA Health Connections electronically provides these materials for your convenience. As the ownership and accuracy of the materials fall under the purview of the individual insurance companies, CBIA does not guarantee their precision. Please contact the respective insurance company for the most updated version of these materials.
- Voluntary dental insurance has no minimum employee participation requirement but is subject to the CBIA’s global participation guidelines listed below.
- Employer groups in the CBIA Health Connections program may elect to offer their employees either group or voluntary dental through Ameritas, but not both.
- If an employer chooses to offer voluntary dental to employees, employees may elect one of the five plans offered during the group’s initial enrollment period or at a future open enrollment period. Only new hires or employees with a qualifying event may enroll in voluntary dental mid-year.
- Orthodontia coverage for dependents up to age 19 is included in the Passive PPO 100%/80%/50%-$1,500 plan only.
- Voluntary dental through Ameritas is a network product. Enrollees may save money by using a participating provider.
- Dependent coverage terminates at the end of the month of the dependent’s 26th birthday.
- Employee premium is collected through payroll deduction by the employer. CBIA will bill the employer for this benefit on the monthly billing statement.
CBIA Employee Benefits
Global Participation/Enrollment Guidelines
- Groups with 3 to 9 eligible employees must have enrollment in a minimum of 2 lines of coverage from the CBIA Health Connections product portfolio. Groups with 10 or more eligible employees must have enrollment in at least 1 line of coverage.
- Groups must have at least 3 employees enrolled in one line of coverage from CBIA Health Connections product portfolio which includes: Medical, Dental, Vision, Life, Short Term Disability, Long Term Disability insurance, and Voluntary Accident & Illness Benefits.
Member Services:
- See ID card or call 800.487.5553
- Monday—Thursday: 7 am-12 am, Central Time (CT)
- Friday: 7 am-6:30 pm (CT)
- When prompted to “Select a Network,” choose “Classic (PPO)”
Group Dental
2024 Small Group Plan Summaries with Rates
Valid May through December 2024
- Active PPO 100%/100%/60% $700
- Passive PPO 100%/80%/50% $1,250
- Passive PPO 100%/80%/50% $1,250 w/ Ortho
- Passive PPO 100%/80%/0% $1,000
- Passive PPO 100%/80%/50% $1,000
- Passive PPO 100%/80%/50% $1,000 w/ Ortho
- Passive PPO 100%/80%/50% $1,500
- Passive PPO 100%/80%/50% $1,500 w/ Ortho
- Passive PPO 100%/80%/50% $2,000
- Passive PPO 100%/80%/50% $2,000 w/ Ortho
- Active PPO100%/100%/60% $1,000*
- Active PPO100%/100%/60% $1,000 w/ Ortho*
Valid through April 2024
- Active PPO 100%/100%/60% $700
- Passive PPO 100%/80%/50% $1,250
- Passive PPO 100%/80%/50% $1,250 w/ Ortho
- Passive PPO 100%/80%/0% $1,000
- Passive PPO 100%/80%/50% $1,000
- Passive PPO 100%/80%/50% $1,000 w/ Ortho
- Passive PPO 100%/80%/50% $1,500
- Passive PPO 100%/80%/50% $1,500 w/ Ortho
- Passive PPO 100%/80%/50% $2,000
- Passive PPO 100%/80%/50% $2,000 w/ Ortho
- Active PPO100%/100%/60% $1,000*
- Active PPO100%/100%/60% $1,000 w/ Ortho*
2024 Large Group Plan Summaries with Rates
Valid May through December 2024
- Active PPO 100%/100%/60% $700
- Passive PPO 100%/80%/50% $1,250
- Passive PPO 100%/80%/50% $1,250 w/ Ortho
- Passive PPO 100%/80%/0% $1,000
- Passive PPO 100%/80%/50% $1,000
- Passive PPO 100%/80%/50% $1,000 w/ Ortho
- Passive PPO 100%/80%/50% $1,500
- Passive PPO 100%/80%/50% $1,500 w/ Ortho
- Passive PPO 100%/80%/50% $2,000
- Passive PPO 100%/80%/50% $2,000 w/ Ortho
- Active PPO100%/100%/60% $1,000*
- Active PPO100%/100%/60% $1,000 w/ Ortho*
Valid through April 2024
- Active PPO 100%/100%/60% $700
- Passive PPO 100%/80%/50% $1,250
- Passive PPO 100%/80%/50% $1,250 w/ Ortho
- Passive PPO 100%/80%/0% $1,000
- Passive PPO 100%/80%/50% $1,000
- Passive PPO 100%/80%/50% $1,000 w/ Ortho
- Passive PPO 100%/80%/50% $1,500
- Passive PPO 100%/80%/50% $1,500 w/ Ortho
- Passive PPO 100%/80%/50% $2,000
- Passive PPO 100%/80%/50% $2,000 w/ Ortho
- Active PPO100%/100%/60% $1,000*
- Active PPO100%/100%/60% $1,000 w/ Ortho*
Voluntary Dental
Life & Disability
Life and disability claim forms/applications for benefits can be submitted to CBIA or The Hartford.
CBIA will work with Hartford Life to set up the claim in their system. Once a claim determination has been made by Hartford Life and the claimant has been notified, all inquiries should be made directly to Hartford Life.
Claims can also be started directly with The Hartford at TheHartford.com/mybenefits.
Click here for a complete list of digital capabilities of The Hartford’s My Benefits claims portal.
LTD and STD Claims
CBIA
350 Church Street
Hartford, CT 06103-1126
fax: (860) 278-0883
HLI@cbia.com
OR
The Hartford
Benefit Management Services
Disability Claim Office
P.O. Box 14303
Lexington, KY 40512-4303
phone STD: (800) 538-8439
phone LTD: (800) 538-0134
fax: (877) 431-8901
Waiver of Premium
Send claim form to:
The Hartford
Group Benefit Claims
PO Box 14296
Lexington, KY 40512-4296
or fax to: Group Benefit Claims at (877) 467-3037
Phone: (888) 563-1124
Conversion & Portability Unit
The Hartford
P. O. Box 248108
Cleveland, OH 44124-8108
or for overnight mail:
The Hartford
6110 Parkland Blvd
Cleveland, OH 44124-4187
phone: (877) 320-0484
fax: (440)646-9339
Hartford Life and AD&D Claim Office
CBIA
350 Church Street
Hartford, CT 06103-1126
fax: (860) 278-0883
HLI@cbia.com
OR
Hartford Life
Group Life Claims
P.O. Box 2999
Hartford, CT 06104-2999
phone: (888) 563-1124
fax: (860) 843-8567
Death Claims
CBIA
350 Church Street
Hartford, CT 06103-1126
fax: (860) 278-0883
HLI@cbia.com
- Non-medical Employer Participation Agreement Form
- Non-medical Employee Enrollment/Change Form
- Online Access Request
Life
- Absolute Assignment Form
- Beneficiary Designation Form
- Conversion Privilege Form and Notification
- Life and AD&D Claim Form – No Safe Haven
- Life and AD&D Claim Form – With Safe Haven
- Life Insurance Portability / Conversion Form
- Statement of Claim for Living Benefits/Acceleration of Death Benefits
- Supplemental Life Employer Enrollment Form
- Supplemental Life Employee Enrollment Form
- Supplemental Life Portability Rates
- Understanding Group Life Insurance & Beneficiary Designations
- Voluntary Dependent Life: Children with Disabilities Eligibility Form
- Waiver of Premium Application
Vision
CBIA Health Connections provides these materials electronically for your convenience. As UnitedHealthcare owns the content, CBIA does not guarantee its accuracy. For the most up-to-date information, please contact UnitedHealthcare.
Member Services:
- 800.638.3120
- Monday—Friday: 8 am-11 pm, Eastern Time (ET)
- Saturday: 9 am-6:30 pm (ET)
Voluntary Vision Insurance Group Participation/Enrollment Guidelines
- Voluntary vision insurance has no minimum employee participation requirement but is subject to the CBIA’s global participation guidelines (see below).
- Employers have access to two plan options and must select one to offer their workforce.
- Employees can opt for voluntary vision insurance during the initial enrollment period or subsequent open enrollment periods. Mid-year enrollment is exclusive to new hires or those experiencing a qualifying life event.
- Benefits operate on a “date of service” basis. For example, if a benefit is claimable once every 12 months, eligibility resets from the date the last service was utilized.
- Utilizing UnitedHealthcare’s network for voluntary vision insurance can lead to cost savings for enrollees.
- Coverage for dependents ceases at the end of the month in which they turn 26.
- Employee premium is collected through payroll deduction by the employer. CBIA will bill the employer for this benefit on the monthly billing statement.
- Identification cards are not mandatory. For appointments, employees should provide their Social Security Number, name, and date of birth. Alternatively, ID cards can be printed from www.myuhcvision.com by selecting “Print Vision ID Card” under “My Benefits.” ID cards feature a member ID number instead of Social Security Numbers.
- For any inquiries regarding benefits post-enrollment, enrollees can contact UnitedHealthcare customer service at 800.638.3120.
CBIA Employee Benefits Global Participation & Enrollment Guidelines
- Groups with 3 to 9 eligible employees must have enrollment in a minimum of two lines of coverage from the CBIA Health Connections product portfolio. Groups with 10 or more eligible employees must have enrollment in at least one line of coverage.
- Groups must have at least three employees enrolled in one line of coverage from CBIA Health Connections product portfolio which includes: Medical, Dental, Vision, Life, Short Term Disability, Long Term Disability insurance, and Voluntary Accident & Illness Benefits.
Plan Summaries with Rates
Plan Summaries without Rates
Supplemental Health
- Customer Service: 800.523.2233
- Claims:
- Phone: 866.547.4205
- Fax: 469.417.1952
- MyTomorrow: interactive video teaches your employees about Critical Illness Insurance, Accident Insurance, and Hospital Indemnity Insurance and helps them make purchasing decisions. Feel free to copy the link location and forward to your employees or simply use the email template below.
- Cost Calculator: this calculator gives your employees a ballpark estimate of what these benefits may cost them on a per paycheck basis.
- Videos: these brief videos explain why Voluntary Accident & Illness Benefits are important benefit considerations. Feel free to copy the link locations and forward to your employees or simply use the email template below.
- Email Template: copy the information from this template to introduce Voluntary Accident & Illness Benefits to your employees. Links to the interactive tools and videos noted above are included. Feel free to modify the content to suit your needs.
- Non-medical Employer Participation Agreement Form
- Non-medical Employee Enrollment/Change Form
- Online Access Request
- Accident Insurance Claim form for Death Benefits
- Attending Physicians Statement (use for all three benefits)
- Claim Form: Employee portion (use for all three benefits)
- Claim Form: Employer portion (use for all three benefits)
- Enrollment Form (for those with existing CBIA Health Connections coverage only)
- Claim Form: Health Screening Benefit
- Portability Forms
- Voluntary Accident Insurance, Critical Illness Insurance, & Hospital Indemnity Insurance are offered as a package. However, they are considered 3 lines of coverage for participation requirement purposes.
- These lines of coverage have no minimum participation requirements but are subject to the CBIA’s global participation guidelines listed below.
- Employees must select one of two plans (Plan A and Plan B).
- Employees may elect coverage in one, two, or all three products. They are not obligated to purchase all three.
- Employees enroll themselves and their family members during the group’s initial enrollment period or future open enrollment periods. Only new hires may join the plan mid-year.
- Dependent coverage terminates at the end of the month of the dependent’s 26th birthday.
- Employee premium is collected through payroll deduction by the employer. CBIA will bill the employer for this benefit on the monthly billing statement.
CBIA Employee Benefits
Global Participation/Enrollment Guidelines
- Groups with 3 to 9 eligible employees must have enrollment in a minimum of 2 lines of coverage from the CBIA Health Connections product portfolio. Groups with 10 or more eligible employees must have enrollment in at least 1 line of coverage.
- Groups must have at least 3 employees enrolled in one line of coverage from CBIA Health Connections product portfolio which includes: Medical, Dental, Vision, Life, Short Term Disability, Long Term Disability insurance, and Voluntary Accident & Illness Benefits.
Workers Compensation
Todd Kaupin
Vice President, Producer
(413) 750-4289
Todd.Kaupin@usi.com
Steve Grahn
Claims Manager
(855) 874-0123 Ext. 54250
steven.grahn@usi.com
Kimberly A Ferris RN, CCM.
Vice President of Medical Case Management
(413) 750-4213
Kimberly.Ferris@usi.com
Julia Coco
TPA Claims Specialist
(203) 634-2865 Direct
julia.coco@usi.com
Joanne Glenn
Claims Specialist II
(860) 652-1059 Direct
joanne.glenn@usi.com
Margery Thompson RN-BC, BSN, CCM
Nurse Case Manager
(855) 874-0123 Ext. 2072393329
margery.thompson@usi.com
Tony Szwez
Senior Vice President, FutureComp
(855) 874-0123 Ext. 54261
tony.szwez@usi.com
95 Glastonbury Boulevard, Suite 102
Glastonbury, Connecticut 06033
fax: 855.874.1288
Connecticut Paid Family and Medical Leave
Please review the following information if you decide to pursue our private PFML plan and opt-out of the state plan.
- You must register your company on the Connecticut Paid Leave Authority’s website as soon as possible if you haven’t already done so. (All Connecticut employers were required to register by March 1, 2021.)
- You must complete and sign the Declaration of Insurance from The Hartford.
- You must conduct a vote that includes all Connecticut employees before you can opt-out of the State’s program. A simple majority of all Connecticut employees must approve the decision to move forward with a private plan. Review the following information on the employee vote.
- Employees must be given at least two weeks’ notice in advance of the required vote. This sample notice may be used to assist with this obligation.
- The notice must include the date and time of the employee vote.
- A Plain Language Guide and Declaration of Insurance (signed by the employer) must be included with this notification.
- The question presented to the employees for the vote must be:
Do you approve the company’s private plan to provide benefits required by the Connecticut Paid Family and Medical Leave Insurance Act? Yes or No - An employee who abstains from voting is considered a “No” vote.
- You must apply here for an exemption from the state plan. Note that you as the employer must file for this exemption. Brokers and carriers are prohibited from doing this on your behalf. The following documentation will be required:
- The Plain Language Guide that was provided to employees
- The Declaration of Insurance signed by the employer
- Confirmation of the vote
- Once the exemption has been approved, a copy of the approval must be sent to Tom Goszewski of CBIA at 350 Church St., Hartford, CT 06103 or emailed to Tom.Goszewski@cbia.com. CBIA will acknowledge receipt of the approval then process your coverage through The Hartford to begin January 1, 2022.
To request a quote, we need a census in Excel that includes birth date, gender, salary, and work state for all employees including part-time, temporary, and seasonal workers. Employees can not opt-out of coverage.
Agents should send quote requests to Tom Goszewski at tom.goszewski@cbia.com.
If you have any questions about the program, please email Tom or call him at 959.282.4742.