Title Published Office File(s) Page Superior Vision Plan Highlights Jul 14th, 2024 Employee Benefits NEW! Superior Vision Highlights 2024-2025 More Info about Superior Vision Plan Highlights UT FLEX Letter of Medical Necessity Form Aug 30th, 2024 Employee Benefits Letter of Medical Necessity More Info about UT FLEX Letter of Medical Necessity Form UT FLEX Health Care Reimbursement Claim Form Feb 16th, 2024 Employee Benefits UT FLEX HCRA Claim Form More Info about UT FLEX Health Care Reimbursement Claim Form Beneficiary Designation Form Mar 1st, 2020 Employee Benefits Beneficiary Designation Form More Info about Beneficiary Designation Form Accidental Dismemberment Claim Form Mar 1st, 2020 Employee Benefits Accidental Dismemberment Claim Form More Info about Accidental Dismemberment Claim Form Death Claim Form Mar 1st, 2020 Employee Benefits Death Claim Form More Info about Death Claim Form Life Portability Application Mar 1st, 2020 Employee Benefits Life Portability Application More Info about Life Portability Application Life Conversion Application Mar 1st, 2020 Employee Benefits Application to Convert Group Life Insurance More Info about Life Conversion Application Life and AD&D Brochure for Active Employees Sep 1st, 2024 Employee Benefits Life and AD&D Benefit Brochure for Active Employees More Info about Life and AD&D Brochure for Active Employees Accidental Death & Dismemberment Certificate Jul 15th, 2024 Employee Benefits Accidental Death & Dismemberment Certificate (effective 09/01/2024) Accidental Death & Dismemberment Certificate (expires 09/01/2024) More Info about Accidental Death & Dismemberment Certificate Short Term Disability Brochure Sep 1st, 2021 Employee Benefits NEW! 2021-2022 Short Term Disability Brochure 2020-2021 Short Term Disability Brochure More Info about Short Term Disability Brochure LTD Conversion Calculator Sep 1st, 2013 Employee Benefits LTD Conversion Calculator More Info about LTD Conversion Calculator Long-Term Disability Conversion Kit Mar 15th, 2020 Employee Benefits Long Term Disability Conversion Kit More Info about Long-Term Disability Conversion Kit LTD Employer Claim Form Mar 3rd, 2020 Employee Benefits LTD Employer Claim Form More Info about LTD Employer Claim Form LTD Employee Claim Form Mar 1st, 2020 Employee Benefits LTD Employee Claim Form More Info about LTD Employee Claim Form Long-Term Disability Benefit Highlights Sep 1st, 2021 Employee Benefits NEW! 2021-2022 Long Term Disability Brochure 2020-2021 Long Term Disability Brochure More Info about Long-Term Disability Benefit Highlights Medicaid and the Children's Health Insurance Program (CHIP) Notice Jul 27th, 2018 Employee Benefits Medicaid and the Children's Health Insurance Program (CHIP) Notice More Info about Medicaid and the Children's Health Insurance Program (CHIP) Notice Notice of Creditable Coverage (NOCC) Aug 31st, 2021 Employee Benefits Medicare Part D Notice of Creditable Coverage More Info about Notice of Creditable Coverage (NOCC) UT System Cafeteria Plan Document Jul 1st, 2020 Employee Benefits UT System Cafeteria Plan Document More Info about UT System Cafeteria Plan Document Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Sep 1st, 2023 Employee Benefits Tobacco Cessation Program Physician Statement More Info about Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Annual Leave Deferral Agreement Mar 8th, 2022 Employee Benefits Annual Leave Deferral Agreement More Info about Annual Leave Deferral Agreement DCP Catch-Up Provision Agreement Sep 1st, 2013 Employee Benefits DCP Catch-Up Provision Agreement More Info about DCP Catch-Up Provision Agreement UTSaver DCP - 457(b) Plan Document Jan 1st, 2022 Employee Benefits UTSaver DCP - 457(b) Plan Document More Info about UTSaver DCP - 457(b) Plan Document Comparison of Traditional, Roth 403(b), and Roth IRA Contributions Jan 1st, 2024 Employee Benefits Comparison of Traditional, Roth 403(b), and Roth IRA Contributions More Info about Comparison of Traditional, Roth 403(b), and Roth IRA Contributions Purchase Change Agreement (All plans) Mar 22nd, 2022 Employee Benefits UT Retirement Purchase Change Agreement (All plans) More Info about Purchase Change Agreement (All plans) UTSaver TSA Disclosure Form Sep 1st, 2013 Employee Benefits UTSaver TSA Disclosure Form More Info about UTSaver TSA Disclosure Form UTSaver TSA - 403(b) Plan Document Jan 1st, 2022 Employee Benefits UTSaver TSA - 403(b) Plan Document More Info about UTSaver TSA - 403(b) Plan Document UT Transfer Verification Form (All plans) Sep 1st, 2013 Employee Benefits UT Transfer Verification Form (All plans) More Info about UT Transfer Verification Form (All plans) UTSaver Loan and Inservice Distribution Options Feb 4th, 2022 Employee Benefits UTSaver Loan and Inservice Distribution Options More Info about UTSaver Loan and Inservice Distribution Options Voluntary Retirement Programs At a Glance Jan 1st, 2024 Employee Benefits Voluntary Retirement Programs More Info about Voluntary Retirement Programs At a Glance Vesting/Termination Status Form Dec 8th, 2015 Employee Benefits Vesting/Termination Status Form More Info about Vesting/Termination Status Form TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund) Oct 1st, 2019 Employee Benefits TRS Form 28 (Oct 2019) More Info about TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund) ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE Sep 1st, 2013 Employee Benefits ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE More Info about ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE ORP Authorization for Reduction for Employee Contribution Sep 1st, 2013 Employee Benefits ORP Authorization for Reduction for Employee Contribution More Info about ORP Authorization for Reduction for Employee Contribution ORP Acknowledgement Jan 1st, 2015 Employee Benefits ORP Acknowledgement More Info about ORP Acknowledgement Optional Retirement Program (ORP) Plan Document Jan 1st, 2022 Employee Benefits Optional Retirement Program (ORP) Plan Document More Info about Optional Retirement Program (ORP) Plan Document Overview of TRS and ORP Aug 11th, 2021 Employee Benefits TRS and ORP Overview - July 2021 More Info about Overview of TRS and ORP HIPAA Policy 1.0: Introduction & Definitions Sep 23rd, 2013 Employee Benefits HIPAA Policy 1.0: Introduction & Definitions More Info about HIPAA Policy 1.0: Introduction & Definitions HIPAA Policy 2.0: Organization of System for HIPAA Privacy Standard Compliance Purposes Sep 23rd, 2013 Employee Benefits HIPAA Policy 2.0: Organization of System for HIPAA Privacy Standard Compliance Purposes More Info about HIPAA Policy 2.0: Organization of System for HIPAA Privacy Standard Compliance Purposes HIPAA Policy 3.0: Breach Notification Policy Jan 20th, 2017 Employee Benefits HIPAA Policy 3.0: Breach Notification Policy More Info about HIPAA Policy 3.0: Breach Notification Policy HIPAA Policy 4.0: PHI Requests, Access, Uses and Disclosures Sep 23rd, 2013 Employee Benefits HIPAA Policy 4.0: PHI Requests, Access, Uses and Disclosures More Info about HIPAA Policy 4.0: PHI Requests, Access, Uses and Disclosures HIPAA Policy Section 4.1: Requests for PHI Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.1: Requests for PHI More Info about HIPAA Policy Section 4.1: Requests for PHI HIPAA Policy Section 4.2: Access to System PHI Feb 1st, 2017 Employee Benefits HIPAA Policy Section 4.2: Access to System PHI More Info about HIPAA Policy Section 4.2: Access to System PHI HIPAA Policy Section 4.3: Uses and Disclosures Required by Law Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.3: Uses and Disclosures Required by Law More Info about HIPAA Policy Section 4.3: Uses and Disclosures Required by Law HIPAA Policy Section 4.4: Discretionary Uses and Disclosures Without An Authorization Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.4: Discretionary Uses and Disclosures Without An Authorization More Info about HIPAA Policy Section 4.4: Discretionary Uses and Disclosures Without An Authorization HIPAA Policy Section 4.5: Conducting Underwriting Activities Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.5: Conducting Underwriting Activities More Info about HIPAA Policy Section 4.5: Conducting Underwriting Activities HIPAA Policy Section 4.6: Research Disclosures and Uses Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.6: Research Disclosures and Uses More Info about HIPAA Policy Section 4.6: Research Disclosures and Uses HIPAA Policy Section 4.7: Making Notification Disclosures Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.7: Making Notification Disclosures More Info about HIPAA Policy Section 4.7: Making Notification Disclosures HIPAA Policy Section 4.8: Review of Requests for Use or Disclosure Requiring Approval by the Privacy Officer Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.8: Review of Requests for Use or Disclosure Requiring Approval by the Privacy Officer More Info about HIPAA Policy Section 4.8: Review of Requests for Use or Disclosure Requiring Approval by the Privacy Officer HIPAA Policy Section 4.9: Minimum Necessary Standard for Uses and Disclosures of PHI Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.9: Minimum Necessary Standard for Uses and Disclosures of PHI More Info about HIPAA Policy Section 4.9: Minimum Necessary Standard for Uses and Disclosures of PHI HIPAA Policy Section 4.10: Verification of Requestor’s Identity and Authority Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.10: Verification of Requestor’s Identity and Authority More Info about HIPAA Policy Section 4.10: Verification of Requestor’s Identity and Authority HIPAA Policy Section 4.11: Obtaining and Relying Upon an Authorization Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.11: Obtaining and Relying Upon an Authorization More Info about HIPAA Policy Section 4.11: Obtaining and Relying Upon an Authorization HIPAA Policy Section 4.12: Personal Representatives Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.12: Personal Representatives More Info about HIPAA Policy Section 4.12: Personal Representatives HIPAA Policy Section 4.13: De-identified Information Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.13: De-identified Information More Info about HIPAA Policy Section 4.13: De-identified Information HIPAA Policy Section 4.14: Documentation of Disclosures Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 4.14: Documentation of Disclosures More Info about HIPAA Policy Section 4.14: Documentation of Disclosures HIPAA Policy 5.0: Office of Employee Benefits As a Plan Sponsor Sep 23rd, 2013 Employee Benefits HIPAA Policy 5.0: Office of Employee Benefits As a Plan Sponsor More Info about HIPAA Policy 5.0: Office of Employee Benefits As a Plan Sponsor HIPAA Policy 6.0: Relationships With Other Entities Sep 23rd, 2013 Employee Benefits HIPAA Policy 6.0: Relationships With Other Entities More Info about HIPAA Policy 6.0: Relationships With Other Entities HIPAA Policy Section 6.1: Contracts With Business Associates Involving Office of Employment Benefits PHI Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 6.1: Contracts With Business Associates Involving Office of Employment Benefits PHI More Info about HIPAA Policy Section 6.1: Contracts With Business Associates Involving Office of Employment Benefits PHI HIPAA Policy Section 6.2: Contracts Involving PHI Entered into by System Offices that are Business Associates of OEB or other Covered Entities. Sep 23rd, 2013 Employee Benefits Section 6.2: Contracts Involving PHI Entered into by System Offices that are Business Associates of OEB or other Covered Entitie More Info about HIPAA Policy Section 6.2: Contracts Involving PHI Entered into by System Offices that are Business Associates of OEB or other Covered Entities. HIPAA Policy Section 6.3: Carriers Providing Group Health Plan Coverage Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 6.3: Carriers Providing Group Health Plan Coverage More Info about HIPAA Policy Section 6.3: Carriers Providing Group Health Plan Coverage HIPAA Policy Section 6.4: Agreements With Recipients of a Limited Data Set Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 6.4: Agreements With Recipients of a Limited Data Set More Info about HIPAA Policy Section 6.4: Agreements With Recipients of a Limited Data Set HIPAA Policy 7.0: Individual Rights Sep 23rd, 2013 Employee Benefits HIPAA Policy 7.0: Individual Rights More Info about HIPAA Policy 7.0: Individual Rights HIPAA Policy Section 7.1: Notice of Individual Rights Concerning PHI Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.1: Notice of Individual Rights Concerning PHI More Info about HIPAA Policy Section 7.1: Notice of Individual Rights Concerning PHI HIPAA Policy Section 7.2: Right to Access Protected Health Information Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.2: Right to Access Protected Health Information More Info about HIPAA Policy Section 7.2: Right to Access Protected Health Information HIPAA Policy Section 7.3: Requests to Amend PHI Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.3: Requests to Amend PHI More Info about HIPAA Policy Section 7.3: Requests to Amend PHI HIPAA Policy Section 7.4: Right to Receive an Accounting of Disclosures Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.4: Right to Receive an Accounting of Disclosures More Info about HIPAA Policy Section 7.4: Right to Receive an Accounting of Disclosures HIPAA Policy Section 7.5: Requests for Restrictions on Use and Disclosure Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.5: Requests for Restrictions on Use and Disclosure More Info about HIPAA Policy Section 7.5: Requests for Restrictions on Use and Disclosure HIPAA Policy Section 7.6: Requests for Confidential Communications Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.6: Requests for Confidential Communications More Info about HIPAA Policy Section 7.6: Requests for Confidential Communications HIPAA Policy Section 7.7: Right to Make A Complaint Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 7.7: Right to Make A Complaint More Info about HIPAA Policy Section 7.7: Right to Make A Complaint HIPAA Policy 8.0: Ensuring Privacy Compliance Sep 23rd, 2013 Employee Benefits HIPAA Policy 8.0: Ensuring Privacy Compliance More Info about HIPAA Policy 8.0: Ensuring Privacy Compliance HIPAA Policy Section 8.1: Cooperation With the Secretary’s Investigation Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 8.1: Cooperation With the Secretary’s Investigation More Info about HIPAA Policy Section 8.1: Cooperation With the Secretary’s Investigation HIPAA Policy Section 8.2: Training Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 8.2: Training More Info about HIPAA Policy Section 8.2: Training HIPAA Policy Section 8.3: Safeguarding PHI Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 8.3: Safeguarding PHI More Info about HIPAA Policy Section 8.3: Safeguarding PHI BAC By-Laws Mar 7th, 2017 Employee Benefits BAC By-laws More Info about BAC By-Laws HIPAA Policy Section 8.4: Mitigation of Known Privacy Violations Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 8.4: Mitigation of Known Privacy Violations More Info about HIPAA Policy Section 8.4: Mitigation of Known Privacy Violations HIPAA Policy Section 8.5: Sanctions for Personnel Violations of Privacy Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 8.5: Sanctions for Personnel Violations of Privacy More Info about HIPAA Policy Section 8.5: Sanctions for Personnel Violations of Privacy HIPAA Policy 9.0: Documentation Sep 23rd, 2013 Employee Benefits HIPAA Policy 9.0: Documentation More Info about HIPAA Policy 9.0: Documentation HIPAA Policy Section 9.1: Changes to Privacy Policies and Procedures Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 9.1: Changes to Privacy Policies and Procedures More Info about HIPAA Policy Section 9.1: Changes to Privacy Policies and Procedures HIPAA Policy Section 9.2: Retention of Privacy Documentation Sep 23rd, 2013 Employee Benefits HIPAA Policy Section 9.2: Retention of Privacy Documentation More Info about HIPAA Policy Section 9.2: Retention of Privacy Documentation HIPAA Request for Access to Protected Health Information Feb 1st, 2017 Employee Benefits Request for Access Form More Info about HIPAA Request for Access to Protected Health Information Pagination « « First ‹ ‹ Previous 1 2 3 4 5 6 7 8 9 … › Next › » Last »