Documents by Office

Documents by Office

Documents by Office

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Employee Benefits
Document Publish Date File
150. Program to Prevent, Detect & Mitigate Identity Theft August 1, 2009
160. Tobacco Premium Program September 1, 2012
210. Employees September 1, 2015
211. Certain Non-Employees June 1, 2013
220. Retired Employees April 15, 2015
230. Dependents July 1, 2015
24/7 Nurseline December 17, 2014
240. Surviving Dependents September 1, 2008
250. COBRA Participants September 1, 2005
260. Health Insurance Premium Payment (HIPP) Reimbursement Program September 1, 2008
270. Evidence of Insurability (EOI) January 1, 2015
310. Qualified Status Change Events January 1, 2015
320. Active Military Duty July 1, 2010
400. Health Insurance Portability and Accountability Act (HIPAA) September 23, 2013
570. UT FLEX Program September 1, 2010
571. UT FLEX Contribution Reporting August 1, 2013
572. Address Change Procedures for UT FLEX Debit Card Participants November 1, 2008
573. Annual Base Benefit Rate (ABBR) Calculation September 1, 2013
701. Premium Billing & Reconciliation November 1, 2015
702. Billing of Postage to Components April 1, 2014
705. Employee Assistance Program September 1, 2004
706. BCBS Eligibility Audit April 1, 2014
707. Retroactive Eligibility Adjustments April 1, 2014
810. Optional Retirement Program April 1, 2006
820. UTSaver Tax-Sheltered Annuity Program December 7, 2004
830. UTSaver Deferred Compensation Plan August 1, 2005
840. Investment Policy Statement March 1, 2010
About Online Beneficiary Management September 1, 2013
Accelerated Death Claim Form September 1, 2013
Accidental Death & Dismemberment Benefits Guide September 1, 2013
Accidental Dismemberment Claim Form September 1, 2013
Annual Eligibility Notice for Retirement Plans April 24, 2015
Annual Enrollment & Resource Guide for Employees 2015-2016 July 15, 2015
Annual Enrollment & Resource Guide for Retired Employees 2015-2016 July 15, 2015
Beneficiary Designation Form September 1, 2013
Benefits Cost Worksheet for Employees 2015-2016 July 10, 2015
Benefits Cost Worksheet for Retired Employees 2015-2016 July 10, 2015
COBRA General Notice August 25, 2015
Comparison of Traditional, Roth 403(b), and Roth IRA Contributions January 1, 2015
Create Your Own Will Online September 1, 2013
DCP Catch-Up Provision Agreement September 1, 2013
DCP Purchase Agreement September 1, 2013
Death Claim Form September 1, 2013
Delta Dental Online Services September 1, 2013
DeltaCare - Getting the Most from Your Dental HMO September 1, 2013
DeltaCare Benefits Guide September 1, 2013
DeltaCare Highlights September 1, 2013
Filing Your STD Claim September 1, 2013
Finding-In-Network Providers September 1, 2014
Flexible Spending Accounts (FSA) Flyer September 1, 2013
Getting Started with the Online Member Portal September 1, 2014
Grandchild Certification Form July 1, 2012
HealthHub (utflex.com) Quick Reference Guide September 1, 2013
Helpful Hints for Completing the Direct Payment Agreement September 1, 2013
HIPAA Breach Log September 23, 2013
HIPAA Complaint Form September 23, 2013
HIPAA Disclosure Log September 23, 2013
HIPAA General Authorization Form September 23, 2013
HIPAA Hybrid Entity Designation September 23, 2013
HIPAA Notice of Privacy Practices September 1, 2013
HIPAA Policy 1.0: Introduction & Definitions September 23, 2013
HIPAA Policy 2.0: Organization of System for HIPAA Privacy Standard Compliance Purposes September 23, 2013
HIPAA Policy 3.0: Breach Notification Policy September 23, 2013
HIPAA Policy 4.0: PHI Requests, Access, Uses and Disclosures September 23, 2013
HIPAA Policy 5.0: Office of Employee Benefits As a Plan Sponsor September 23, 2013
HIPAA Policy 6.0: Relationships With Other Entities September 23, 2013
HIPAA Policy 7.0: Individual Rights September 23, 2013
HIPAA Policy 8.0: Ensuring Privacy Compliance September 23, 2013
HIPAA Policy 9.0: Documentation September 23, 2013
HIPAA Policy Section 4.10: Verification of Requestor’s Identity and Authority September 23, 2013
HIPAA Policy Section 4.11: Obtaining and Relying Upon an Authorization September 23, 2013
HIPAA Policy Section 4.12: Personal Representatives September 23, 2013
HIPAA Policy Section 4.13: De-identified Information September 23, 2013
HIPAA Policy Section 4.14: Documentation of Disclosures September 23, 2013
HIPAA Policy Section 4.1: Requests for PHI September 23, 2013
HIPAA Policy Section 4.2: Access to System PHI September 23, 2013
HIPAA Policy Section 4.3: Uses and Disclosures Required by Law September 23, 2013
HIPAA Policy Section 4.4: Discretionary Uses and Disclosures Without An Authorization September 23, 2013
HIPAA Policy Section 4.5: Conducting Underwriting Activities September 23, 2013
HIPAA Policy Section 4.6: Research Disclosures and Uses September 23, 2013
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