Publications and Forms

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• AE Highlights for Employees
• Group Benefits Handbook for Employees
• Office of Employee Benefits Administrative Manual

MEDICAL - Blue Cross and Blue Shield of Texas

• UT SELECT Benefits Summary Chart
• UT SELECT Benefits Guide (Available by Sep. 1)
• Your UT SELECT Health Benefits at a Glance
• Blue Care Connection Flyer
• Medical Claim Form
• Tobacco Cessation and Weigt Management Programs
• Condition Management Programs

PHARMACY - Medco

• Prescription Drug Program at a Glance
• Medco by Mail Order Form
• Prescription Drug Reimbursement Form
• Coordination of Benefits/Direct Claim Form

DENTAL

• UT SELECT DENTAL Benefits Guide Delta Dental
• UT SELECT DENTAL Claim Form Delta Dental
• UT SELECT DENTAL Benefits Brochure Delta Dental
• Finding a Dentist Flyer Delta Dental
• Your Plan and the DPO Network Delta Dental
• Assurant Dental HMO Option Booklet Assurant Employee Benefits
• Assurant Dental Evidence of Coverage Assurant Employee Benefits

VISION - Superior Vision

• Superior Vision Benefits Guide
• Provider Nomination Form
• Superior Vison Claim Form
• Superior Vision Benefits Brochure
• Getting Started with the Online Member Portal
• Smart Alert - Partnering for Total Wellness
• SVContacts.com - Online Contact Lens Ordering
• Finding-In-Network Providers

UT FLEX - PayFlex Systems

• UT FLEX Benefits Guide (Available by Sep. 1)
• 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) Dearborn National

• Group Term Life Benefits Guide
• Accidental Death & Dismemberment Benefits Guide
• Portability and Conversion of Life Insurance
• Life Conversion Application
• Life Portability Application
• Death Claim Form
• Accelerated Death Claim Form
• Waiver of Premium Claim Form
• Accidental Dismemberment Claim Form
• Life/AD&D Benefit Highlights for Active Employees
• Life Benefit Highlights for Retired Employees
• About Online Beneficiary Management
• Beneficiary Designation Form
• AD&D Enhancements
• Create Your Own Will Online
• Freedome Account

SHORT TERM DISABILITY (STD) - Dearborn National

• Short Term Disability Benefits Guide
• Short Term Disability Highlights
• Blue Care Link
• Filing Your STD Claim

LONG TERM DISABILITY (LTD) - Dearborn National

• Long Term Disability Benefits Guide
• Long Term Disability Benefit Highlights
• LTD Employee Claim Form
• LTD Employer Claim Form
• LTD Conversion Kit
• LTD Conversion Calculator

LONG TERM CARE (LTC) - CNA

• LTC Enrollment Form for new employees
• LTC Short Form Application for current employees and spouses
• LTC Long Form Application for all other applicants
• Long Term Care Guide
• Long Term Care Highlights
• Why You Should Consider Long Term Care
• Introducing Long Term Care