Insurance/Health, Life, and Retirement

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Aetna Application Forms

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.01

Purpose

This record series consists of Aetna application forms maintained by the Office of Insurance/Health, Life, and Retirement.  The records include original applications of university employees enrolled in Aetna health insurance programs including beneficiary designations and premium history (e.g. amount of premiums paid out over time).

Procedure

Retain in office for ten (10) years following termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Annuitant Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.02

Purpose

This record series consists of the annuitant files maintained by the Office of Insurance/Health, Life, and Retirement.  The files contain:  duplicate copy of retirement applications and related paperwork, copy of the letter to the retiree (e.g. explanation of benefits), and letters of dependents of deceased employees (e.g. explanation of life insurance policy).  Original records are maintained with the SURS headquarters in Champaign.

Procedure

Retain in office until superseded and/or termination of coverage, then dispose of providing all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

COBRA Extension Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.03

Purpose

This record series consists of the COBRA extension files maintained by the Office of Insurance/Health, Life, and Retirement.  COBRA (Consolidated Omnibus Budget Reconciliation Act) is a federally funded program that provides extension of insurance coverage for ex-employees of the University.  The records provide similar data found in CMS current health enrollments including beneficiary designations, health certificates, and dependent affidavits.  Original records are maintained with the Department of Central Management Services.

Procedure

Retain in office for six (6) years following termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Current Health Enrollment Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.04

Purpose

This record series consists of current health enrollment files maintained by the Office of Insurance/Health, Life, and Retirement.  The files contain all CMS health enrollments and corrections (e.g. change of name) for university employees including beneficiary designations, health certificates, and dependent affidavits.  Originals are maintained with the Department of Central Management Services except for original beneficiary designations which are retained in office.

Procedure

Retain in office for six (6) years following termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated

Health Claims Inquiries

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.05

Purpose

This record series consists of the Health Claims Inquiries maintained by the Office of Insurance/Health, Life, and Retirement.  The records contain inquiries received by the Insurance Office regarding university employee's health insurance claims (e.g. dispute over payment) including written inquires; phone sheets containing a record of phone inquiries; copies of bills and related supporting documentation.

Procedure

Retain in office for five (5) years, then dispose of providing any and all claims documented by the file series have been closed and providing no litigation is pending or anticipated.

Metropolitan Life Deduction Registers

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.06

Purpose

This record series consists of the Metropolitan Life Deduction Registers maintained by the Office of Insurance/Health, Life, and Retirement.  The registers contain similar information retained with the payroll deduction/payroll revocation authorization cards (e.g. employee's name, department designation, premium amount).  Original register information is retained with the Office of Metropolitan Life Insurance Company.

Procedure

Retain in office for six (6) years following termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Northwestern National Life Applications

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.07

Purpose

This record series consists of Northwestern National Life Applications maintained by the Office of Insurance/Health, Life, and Retirement.  The records contain duplicate applications of university employees enrolled in Northwestern National Life Insurance programs.  The records further include beneficiary designations; proof of insurability forms; and all related correspondence.  Original applications are maintained with the Northwestern National Life Insurance Company.

Procedure

Retain in office for six (6) years following termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Payroll Deduction/Revocation of Deduction Authorization Cards

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.08

Purpose

This record series consists of the Payroll Deduction/ Revocation of Deduction Authorization Cards maintained by the Office of Insurance/Health, Life, and Retirement.  The records serve as the original authorization for the direct withdrawal/cancellation of group insurance premiums from employees' payroll warrants.  Specific information includes employee's name, department designation, and the actual amount of the premium.

Procedure

Retain in office for five (5) years following the revocation of deduction or termination of the corresponding employees, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Refund Requests

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.09

Purpose

This record series consists of refund requests maintained by the Office of Insurance/Health, Life, and Retirement.  The records contain requests to the State (CMS) for refunds on overpayment of insurance premiums.

Procedure

Retain in office for three (3) years, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

State University Retirement System (SURS) Administrative Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.1

Purpose

This record series consists of the State University Retirement System administrative files maintained by the Office of Insurance/Health, Life, and Retirement.  The files contain a record of university employee participation in the State University Retirement System including information retained on leaves of absence and name/address changes.  Original records are maintained with the SURS headquarters in Champaign.

Procedure

Retain in office until superseded and/or termination of coverage, then dispose of providing all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

SURS Disability Application Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.11

Purpose

This record series consists of duplicate copies of university employee applications for SURS (State University Retirement System) approval of disability benefits and related paperwork.  Original applications are maintained with the SURS headquarters in Champaign.

Procedure

Retain in office for six (6) years following the date of denial of application for disability benefits or for six (6) years following the termination of disability benefits, whichever is appropriate, then dispose of providing no litigation is pending or anticipated.

SURS Termination Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.12

Purpose

This record series consists of the SURS termination files maintained by the Office of Insurance/Health, Life, and Retirement.  The files contain notifications sent to the State University Retirement System of University employee terminations and a copy of the employee's refund application.  Original records are maintained with the SURS headquarters in Champaign.

Procedure

Retain in office for five (5) years after termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Tax Deferred Annuity Application Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.13

Purpose

This record series consists of duplicate copies of university employee applications for tax deferred annuities maintained by the Office of Insurance.  Original applications are maintained with the employee's respective insurance company.

Procedure

Retain in office for ten (10) years following superseded and/or termination of enrollment then dispose of providing all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Tax Deferred Annuity

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.14

Purpose

This record series consists of deduction cards (current and terminated) for tax deferred annuities of university employees which are maintained by the Office of Insurance/Health, Life, and Retirement.

Procedure

Retain in office for ten (10) years following superseded and/or termination of enrollment, then dispose of providing all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Termination Files

Arranged By:   Alphabetical
Application Number:   89-23
Item Number:   230.15

Purpose

This record series consists of the termination files maintained by the Office of Insurance/Health, Life, and Retirement.  The records contain duplicate copies of employee insurance termination forms.  Originals are maintained with the Department of Central Management Services in Springfield.

Procedure

Retain in office for five (5) years after termination of coverage, then dispose of provided all audits have been completed under the supervision of the Auditor General, if necessary, and no litigation is pending or anticipated.

Contact Us

Ethics and Compliance Office
Health Services Building, 2nd floor
815-753-5560
eco@niu.edu