Forms and Publications

Benefits Guides

Benefits Guides provide detailed information about the benefits you are entitled to and the provisions of the insurance plans. Benefits Guides may also be titled Plan Certificate, Evidence of Coverage, Summary of Benefits, Certificate of Insurance, Certificate of Coverage, or Policy.

You will need Adobe Acrobat Reader to view the following PDF files. You may view these documents in your browser window or download them to your hard drive. If you need assistance with forms please contact your local Benefits Office.

Group Benefits Handbooks

• Group Benefits Handbook for Employees
• Group Benefits Handbook for Retired Employees

MEDICAL, DENTAL and VISION

• UT SELECT Benefits Guide Blue Cross and Blue Shield of Texas
• Assurant Dental Evidence of Coverage Assurant Employee Benefits
• UT SELECT DENTAL Benefits Guide Delta Dental
• Superior Vision Benefits Guide Superior Vision

UT FLEX - PayFlex Systems

• UT FLEX Benefits Guide

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

• Group Term Life Benefits Guide
• Accidental Death & Dismemberment Benefits Guide

DISABILITY - The Hartford

• Short Term Disability Benefits Guide
• Long Term Disability Benefits Guide

LONG TERM CARE (LTC) - CNA

• Long Term Care Guide