2009-2010 Publications and Forms

Benefit Changes Beginning September 1, 2009 - NEW Quick Summery

Group Benefits Handbook for Employees

Group Benefits Handbook for Retired Employees

Office of Employee Benefits Administrative Manual

MEDICAL - Blue Cross and Blue Shield of Texas

• UT SELECT Benefits Summary Chart
• UT SELECT Benefits Guide - New version available by September 1, 2009
• Your UT SELECT Health Benefits at a Glance
• Medical Claim Form
• Tobacco Cessation
• Weight Management
• Prescription Drug Program at a Glance Medco Health
• Medco by Mail Order Form Medco Health
• Prescription Drug Reimbursement Form Medco Health
• Coordination of Benefits/Direct Claim Form

DENTAL

• Assurant Dental HMO Option Booklet Assurant Employee Benefits
• Assurant Dental Evidence of Coverage Assurant Employee Benefits - New Guide will be available by September 1, 2009
• UT SELECT DENTAL Benefits Guide Delta Dental - New version available by September 1, 2009
• UT SELECT DENTAL Claim Form Delta Dental
• UT SELECT DENTAL Brochure Delta Dental
• Finding a Dentist Flyer Delta Dental
• Your Plan and the DPO Network Delta Dental

VISION - Superior Vision

• Superior Vision Benefits Guide - New version available by September 1, 2009
• Provider Nomination Form
• Superior Vision Benefits Brochure
• Getting Started with the Online Member Portal
• Smart Alert - Partnering for Total Wellness
• SVContacts.com - Online Contact Lens Ordering
• Vision Care Learning
• The Superior Difference
• #1 In Customer Service

UT FLEX - PayFlex Systems

• UT FLEX Benefits Guide - New version available by September 1, 2009
• Payflex Quick Reference Guide
• UT FLEX Claim Form
• Direct Deposit Authorization Form
• Letter of Medical Necessity Form
• The PayFlex Debit Card
• Flexible Spending Accounts (FSA) Brochure

LIFE & ACCIDENTAL DEATH and DISMEMBERMENT(AD&D) Fort Dearborn Life

• Group Term Life Benefits Guide - New version available by September 1, 2009
• Accidental Death & Dismemberment Benefits Guide - New version available by September 1, 2009
• Life/AD&D Benefits Highlights for Active Employees
• Life Benefit Highlights for Retired Employees
• Beneficiary Designation Form

SHORT TERM DISABILITY (STD) - Fort Dearborn Life

• Short Term Disability Benefits Guide - New version available by September 1, 2009
• Short Term Disability Highlights
• Blue Care Link

LONG TERM DISABILITY (LTD) - Fort Dearborn Life

• Long Term Disability Benefits Guide - New version available by September 1, 2009
• Long Term Disability Highlights

LONG TERM CARE (LTC) - CNA

• Long Term Care Guide
• Long Term Care Highlights
• Why You Should Consider Long Term Care
• Introducing Long Term Care

Other

• 2009-2010 Benefits Cost Worksheet
  
• Transitional Benefits Form
  
• Chapter 1601 of the Texas Insurance Code
  
• Coverage For Incapacitated Child Form
• Optional Retirement Program (ORP) Certification Form
  
• Office of Employee Benefits Organizational Chart
  
• HIPAA Privacy Information
  
• HIPAA Security of Electronic Protected Health Information (PHI) COMPLIANCE MANUAL