Vendor Contacts & Legal Notices

Phone numbers and websites for every benefit vendor, plus Dartmouth's required legal notices. For anything a vendor can't resolve, or a notice you can't find, contact the Benefits Office at (603) 646-3588 or Human.Resources.Benefits@dartmouth.edu.

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Vendor Contacts Required Legal Notices SBC Summary of Benefits Summary Plan Descriptions Summaries of Material Modifications Retirement Plan Notices Summary Annual Report Annual Notices

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Vendor Contacts

For claims, ID cards, and account access, go directly to the vendor. For eligibility, enrollment, or anything a vendor can't resolve, contact the Benefits Office.

Vendor	Covers	Phone	Website
Cigna	Medical, HRA, Mental Health Exception, Medical Benefits Abroad (MBA)	(855) 869-8619	mycigna.com
Express Scripts	Pharmacy	(877) 788-5766	express-scripts.com
Fidelity	401(a), SRA, HSA, Retirement Counseling	(800) 343-0860	netbenefits.com
TIAA	401(a), SRA, Retirement Counseling	(800) 842-2252	tiaa.org
Lincoln Financial Group	Life Insurance, LTD, STD, FMLA	(800) 213-1531	mylincolnportal.com
Sentinel Benefits	FSA, Lifestyle Spending Account, COBRA	(888) 762-6088	sentinelgroup.com
VSP	Vision (standalone plan)	(800) 877-7195	vsp.com
Northeast Delta Dental	Dental	(800) 832-5700	nedelta.com
Lyra Health	Faculty and Employee Assistance Program	(844) 614-2846	dartmouth.lyrahealth.com
One Medical at Dartmouth	Primary care in Hanover	(603) 738-1164	onemedical.com/dartmouth
Cigna Voluntary Benefits Claims	Hospital Indemnity, Accident, Critical Illness	(800) 754-3207	mycigna.com

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Required Legal Notices

Summaries of Benefits and Coverage, Summary Annual Reports, and other federally required disclosures. The 2027 annual notices are in the Annual Notices section below. Looking for a specific notice and can't find it here? Contact the Benefits Office at (603) 646-3588 or Human.Resources.Benefits@dartmouth.edu.

Summary of Benefits and Coverage (SBC)

The SBC is produced by Cigna under federal guidelines to help you understand and compare your health plan choices. Federal law requires access to the SBC for your current plan year and for the upcoming plan year beginning January 1. Since Dartmouth offers more than one Cigna medical plan, an SBC is available for each active employee medical option. To request a printed copy, an accessible copy, or help finding information in these documents, contact the Benefits Office at (603) 646-3588.

All buttons below open PDF files.

OAP SBC (2026) JVISA-OAP SBC (2026) CCF SBC (2026) HDHP with HRA SBC (2026) HDHP with HSA SBC (2026) OAP SBC (2027), coming soon JVISA-OAP SBC (2027), coming soon CCF SBC (2027), coming soon HDHP with HRA SBC (2027), coming soon HDHP with HSA SBC (2027), coming soon

Summary of Benefits (SoB)

A plain-language document outlining the key features, costs, and coverage details of Dartmouth's medical and pharmacy plans, including the Dartmouth College Medicare Supplement Plan (DCMS) for retirees.

All buttons below open PDF files.

OAP Summary of Benefits (2026) JVISA-OAP Summary of Benefits (2026) CCF Summary of Benefits (2026) HDHP with HRA Summary of Benefits (2026) HDHP with HSA Summary of Benefits (2026) DCMS Summary of Benefits (2026) OAP Summary of Benefits (2027), coming soon JVISA-OAP Summary of Benefits (2027), coming soon CCF Summary of Benefits (2027), coming soon HDHP with HRA Summary of Benefits (2027), coming soon HDHP with HSA Summary of Benefits (2027), coming soon

Summary Plan Descriptions (SPD)

The full plan document for each of Dartmouth's medical plans, including the Dartmouth College Medicare Supplement Plan (DCMS) for retirees. To request a printed copy, an accessible copy, or help finding information in these documents, contact the Benefits Office at (603) 646-3588.

All buttons below open PDF files.

OAP Summary Plan Description JVISA-OAP Summary Plan Description CCF Summary Plan Description HDHP with HRA Summary Plan Description HDHP with HSA Summary Plan Description DCMS Summary Plan Description

Summaries of Material Modifications (SMM)

A Summary of Material Modifications describes changes to a plan since its Summary Plan Description. The 2027 Summary of Material Modifications for the DCMS is available below. The summary for the active medical plans is coming soon. To request a printed copy, an accessible copy, or help finding information in these documents, contact the Benefits Office at (603) 646-3588.

All buttons below open PDF files.

2027 Summary of Material Modifications: Medical Plans (OAP, CCF, HDHP), coming soon 2027 Summary of Material Modifications: DCMS

Retirement Plan Notices

These notices provide information about the 401(a) and SRA plans' features, investments, and fees, plus contact information for the plans' vendors, Fidelity and TIAA. Prefer a printed copy? Contact the Benefits Office at Human.Resources.Benefits@dartmouth.edu or (603) 646-3588.

All buttons below open PDF files.

401(a) Annual Fee Disclosure SRA Annual Fee Disclosure

Summary Annual Reports (SAR)

Summaries of the Form 5500 Annual Return/Report for each Dartmouth benefit plan, filed with the Employee Benefits Security Administration, U.S. Department of Labor, as required under ERISA (the Employee Retirement Income Security Act of 1974). These reports are for plan year 2025. To request a printed copy, an accessible copy, or help finding information in these documents, contact the Benefits Office at (603) 646-3588.

All buttons below open PDF files.

Health and Welfare Benefits Plan SAR (2025) 401(a) Retirement Plan SAR (2025) 403(b) Retirement Plan SAR (2025) Supplemental Retirement Accounts (SRA) SAR (2025)

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Annual Notices

The notices below are for the plan year starting January 1, 2027. They are located on this page on our website. Each section gives a short summary, and the PDF button opens the full notice, which you can download or print.

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Creditable Coverage Special Enrollment Rights Women’s Health and Cancer Rights (WHCRA) Patient Protections Hospital and Fixed Indemnity Newborns’ and Mothers’ Health Protection (NMHPA) GINA Mental Health Parity (MHPAEA) Michelle’s Law USERRA Marketplace Coverage Options Privacy Practices Medicaid and CHIP Premium Assistance

Creditable Coverage Notice for Medicare Part D

If you or your dependents are or will become eligible for Medicare in the next 12 months, Medicare could provide you with additional choices related to your prescription drug coverage. Dartmouth has determined that the prescription drug coverage offered is, on average for all plan participants, expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

Creditable Coverage Notice (PDF)

Notice of Special Enrollment Rights

This notice helps you understand your right to apply for group health coverage. Special enrollment is available in the following situations:

• Loss of other coverage
• Marriage, birth, or adoption
• Medicaid or CHIP eligibility changes

Special Enrollment Rights notice (PDF)

Women’s Health and Cancer Rights Act (WHCRA)

The Dartmouth health plan, as required by the Women’s Health and Cancer Rights Act of 1998, provides coverage for reconstructive surgery following a mastectomy.

Women’s Health and Cancer Rights Act notice (PDF)

Patient Protections

You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the Benefits Office.

Patient Protections notice (PDF)

Hospital and Fixed Indemnity Plan Notice

IMPORTANT: This is a fixed indemnity policy, NOT health insurance.

This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.

Hospital and Fixed Indemnity notice (PDF)

Newborns’ and Mothers’ Health Protection Act (NMHPA)

The health plan may not restrict benefits for a hospital stay to less than 48 to 96 hours based on type of delivery, as required by law.

Newborns’ and Mothers’ Health Protection Act notice (PDF)

Genetic Information Nondiscrimination Act (GINA)

The Genetic Information Nondiscrimination Act of 2008 protects employees against discrimination based on their genetic information. Unless otherwise permitted, your employer may not request or require any genetic information from you or your family members.

GINA notice (PDF)

Mental Health Parity and Addiction Equity Act (MHPAEA)

The Mental Health Parity and Addiction Equity Act of 2008 requires group health plans to treat mental health and substance use disorder benefits the same as medical and surgical benefits in terms of financial requirements (like copays and deductibles) and treatment limits (like visit caps). For information on how medical necessity is determined, contact the Benefits Office.

Mental Health Parity notice (PDF)

Michelle’s Law

When a dependent child loses student status for purposes of the group health plan coverage as a result of a medically necessary leave of absence from a post-secondary educational institution, the group health plan will continue to provide coverage during the leave of absence for up to one year, or until coverage would otherwise terminate under the group health plan, whichever is earlier.

Michelle’s Law notice (PDF)

Uniformed Services Employment and Reemployment Rights Act (USERRA)

The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) sets requirements for continuation of health coverage and reemployment in regard to an employee’s military leave of absence. These requirements apply to medical and dental coverage for you and your dependents. They do not apply to any life, short-term or long-term disability, or accidental death and dismemberment coverage you may have.

USERRA notice (PDF)

Health Insurance Marketplace Coverage Options and Your Health Coverage

This notice provides basic information about the Health Insurance Marketplace and the employment-based health coverage offered by Dartmouth.

Marketplace Coverage Options notice (PDF)

Notice of Privacy Practices

This notice describes how