SAIC Benefits Open Enrollment and Forms

Summary Plan Description Web Site

The SAIC Benefits Summary Plan Descriptions web site is designed to provide employees and their families with important information about available benefit plans, including:

• Life Events Guide — These charts describe benefits and options that may be available when experiencing a major life event like getting married, having a new child or becoming disabled.
• Participating in the Plans — This section provides information on eligibility, coverage, cost of coverage and enrollment.
• Medical Plans — SAIC offers eligible employees comprehensive medical coverage through several preferred provider organization (PPO) plans.
• Dental Plans — SAIC offers different types of dental plan options.
• Vision Plans — Participants may elect coverage for themselves and their families under a vision plan.
• Flexible Spending Accounts — Save money by paying for eligible health care and/or dependent day care expenses on a pre-tax basis.
• Life and Accidental Death and Dismemberment (AD&D Insurance) — SAIC offers several types of financial protection for participants and their families if they were to die or be injured in an accident.
• Disability Programs — This program is designed to provide income in the event a participant becomes ill or disabled and is unable to work for an extended period of time.

About Benefit Election Changes

Benefits elections are made by employees at the time of hire (or as they become eligible), and during the annual Open Enrollment period.

Employees can make changes to benefits for the current benefit plan year (outside of Open Enrollment) such as to add or drop a dependent, by contacting their Human Resources/Benefits Point-of-Contact. The HR POC is available on ISSAIC on their People Directory page and will explain the process based on what change is required.

Please note, Internal Revenue Service (IRS) regulations require that enrollment elections must remain in effect for the entire plan year unless you experience a qualified status change event.

You have 31 days from the date of a qualified status change event to change your elections without waiting until the next Open Enrollment period.

Download Benefits Claim Forms

Commonly used SAIC benefit claim forms may be downloaded from this site by SAIC employees and their family members.

• Please note, the insured employee must sign all forms before they are submitted.
  
  
• Questions about plan benefits should be directed to the plan provider (see website links provided below), or the SAIC employee's Human Resources/Benefits Point-of-Contact (POC). POCs are listed on ISSAIC People Directory pages.
  
  
• If you are an employee with access to ISSAIC, the SAIC Intranet, a complete selection of benefits forms is available via the online Forms Library.
  
  
• For contact information on retirement plans and access to Vanguard, please see our contact information matrix.
  
  

We want to hear from you! Please send your comments or suggestions for future additions to this page.

Medical

Aetna Medical Benefits Request Form - GC-7-23 (84k PDF file*)
For SAIC Self-Insured Plans ONLY. HMO plans do not use a form.

Use this form to file claims for medical benefits for the SAIC Self-Insured Plans ONLY (MedPlus, MedBasic, Dual Coverage, Catastrophic, and Out-of-Area).

For contact or claims information, visit the Aetna Web Site http://www.aetna.com

Use this form for Mental Health/ Substance Abuse treatment claims for employees on SAIC's self-insured medical plans. Employees using EAP services do not need to complete this form.

CIGNA Behavioral Health Web Site: http://www.cignabehavioral.com

Dental

Aetna Dental Benefits Request Form - GC-8-14 (291k PDF file*)
For the SAIC Self-Insured Plan ONLY. DMO plans do not use this claim form.

Use this form to file a claim for dental benefits under the SAIC Dental Plan ONLY (Aetna PPO Plan). DMO plans, including the Aetna DMO plan, do not use this claim form.

For contact or claims information, visit the Aetna Web Site http://www.aetna.com

Flexcomp

Flexible Spending Account Claim Form, Creative Benefits, Inc. (72k PDF file*)
Health Care Reimbursements: For all employees enrolled in a Health Care Spending Account. Employees in an SAIC Self-Insured Plan, also see Flexcomp Annual Authorization Form.
Dependent Care Reimbursements: For all employees enrolled in a dependent care spending account.

Use this form for Health Care and Dependent Care Flexible Spending Account reimbursement claims.

For contact or claims information, visit the Creative Benefits Web Site http://www.crbenefits.com

Flexcomp Annual Authorization (For Health Care Claims ONLY)

If you are enrolled in an SAIC Self-Insured Plan (MedPlus, MedBasic, Dual Coverage, Catastrophic, and Out-of-Area), you have the option to submit a Spending Account Authorization Form (for each calendar year):

FlexComp Health Care Spending Account Authorization for EOB Claim Submission (SAIC Self-Insured Plans Only) (621k PDF file*)
Form used one time per calendar year for employees enrolled in an SAIC Self-Insured Plan ONLY.

This form must be submitted one time only each calendar year and allows those enrolled in an SAIC Self-Insured Medical Plan (MedPlus, MedBasic, Dual Coverage, Catastrophic, and Out-of-Area) to submit your Explanation of Benefits (EOB) without having to submit a separate Spending Account Claim Form with receipt, and without paying out-of-pocket expenses.

Qualified Status Change Events

• Gaining or losing a spouse or dependent due to any of these events:
  • Marriage
  • Divorce, separation or annulment
  • Birth or adoption of a dependent
  • Death of a dependent or spouse
  • A child losing eligibility for coverage (marrying, attaining age 19 or 25, ceasing to be a full-time student, or concluding a religious mission),
  • A child gaining eligibility for coverage (attaining student status or beginning a religious mission not to exceed two years).
• If your spouse, your dependent(s) or you:
  • Change employment status (termination, commencement),
  • Change work schedule (reduction in hours of employment),
  • Change residence or work site that affects an HMO service area,
  • Have to pay an increased amount for benefits mid-year as a result of a health care plan or HMO increase,
  • Become eligible for COBRA or
  • Become entitled to Medicare or Medicaid (MediCal in California).
• Issuance of a family relations judgment (QMCSO - a court order that may require you to provide your children with medical benefits, even if they are not in your custody).

*Note: PDF documents are viewed using Acrobat® Reader®.