Catholic Diocese of Jackson
Assured Benefits Administrators (ABA) 1-800-247-7114
Medical Network Information
- Mississippi Physicians Care Network
- Mississippi Health Partners (effective 01/01/2020)
- CAREVALENT – Facilities Only Coverage
(Effective 01/01/2019 through 12/31/2019 only)
Offering Sheets for 2020
- CDJ – Offering Full Time Employees (30 hours + per week)
- CDJ – Offering Priests
- CDJ – Offering Part Time Employees (20-29 hours per week)
- CDJ – Wellness Benefits
- CDJ – MPCN Labs
- CDJ – Pre-Authorization Handout
- CDJ – Provider Communication
Health Insurance Plans: Self-Insured by the Diocese of Jackson
Third Party Administrator: Assured Benefits Administrator (ABA)
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Call-A-Doc Brochure
- CDJ BASE 7030 Medical Plan (#2516)
- CDJ BASE 7030 Medical Plan – Summary of Benefits
- CDJ BUY-UP 8020 Medical Plan (#2517)
- CDJ BUY-UP 8020 Medical Plan – Summary of Benefits
- CDJ PRIEST Medical Plan (#2518)
- CDJ PRIEST Medical Plan – Summaray of Benefits
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The Hartford – Medicare Supplemental Plan F
Dental Insurance Plans: Ameritas 1-800-659-2223
Hearing & LASIK Plans: Ameritas 1-800-659-2223
Vision Insurance Plans: VSP 1-800-877-7195
FSA Medical and Dependent Care Plans:
Consumer Choice 1-800-811-8194
- Wex FSA-withrollover fact sheet
- Wex FSA-with rollover FAQ
- Elligible Inelligible Expense FSA Only
- FSA Amendment to Cafeteria Plan
- CCP – FSA Claim Form and Direct Deposit Agmt Signature
- Authorization to Use/Disclose Protected Health Information
Cancer Plans: Allstate 1-800-348-4489
- Allstate Group Cancer Brochure
- Allstate Cancer Claim Form
- Allstate Disability Claim Form
- Allstate Wellness Claim Form
Benefit Plan Documents: Mutual of Omaha
- Mutual of Omaha Group Accident Policy
- Mutual of Omaha Group Term Life Policy
- Mutual of Omaha Group Term Life Summary
- Mutual of Omaha PRIESTS Group Term Life Policy
- Mutual of Omaha PRIESTS Group Term Life Summary
- Mutual of Omaha Voluntary Term Life Policy
- Mutual of Omaha Long Term Disability Policy
- Mutual of Omaha Short Term Disability Policy
- Mutual of Omaha Employee Assistance Program
Claim Forms: Mutual of Omaha
Claims 1-800-775-8805
Disability Claim 1-800-877-5176
- Mutual of Omaha Group Life Conversion Form
- Mutual of Omaha Group Accident Claim Form
- Mutual of Omaha Long Term Disability Claim Form
- Mutual of Omaha Short Term Disability Claim Form
- Mutual of Omaha Life Claim Form (Proof of Death)
- Mutual of Omaha Accidental Death Claim Form
- Mutual of Omaha Evidence of Insurability
Prescription Drug Plans: ProAct 1-877-635-9545
- ProAct High Plan Brochure
- ProAct Low Plan Brochure
- ProAct Pharmacy Services Informational Tri-Fold
- ProAct Pharmacy Services Order Form
CDJ Scripts Drug Plan (CanaRX):
Required Notices:
- Medicare Part D Creditable Coverage Letter
- Marketkplace Notification – English
- Marketplace Notification – Spanish
- Annual Notification 2.0 – English
- Annual Notification 2.0 – Spanish
- Special Enrollment Notice Insurance
- Premium Assistance Under Medicaid and the Chips Insurance
- HIPAA Privacy Rule and Security Standards
- Women’s Health Cancer Rights Act Notice Insurance