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Plan Year
2005-2006
2006-2007
2007-2008
2008-2009
Forms and Publications
For the 2006-2007 Plan Year
Benefits Library for HR staff only
Policies
Employee Group Insurance Program Administrative Manual
Employees
Group Benefits Handbook for Employees
Optional Retirement Program (ORP) Certification Form
Retirees
Group Benefits Handbook for Retired Employees
Notice of Creditable Coverage for Medicare Part D
Medical
Health Plan Comparison Chart
HMO Blue Benefits Guide
- BlueCross BlueShield of Texas
HMO Blue Benefits At-A-Glance
- BlueCross BlueShield of Texas
HMO Blue Home Delivery Service Form
- Prime Therapeutics
HMO Blue Primary Care Physician Election Form
- BlueCross BlueShield of Texas
U T SELECT Benefits Guide
- BlueCross BlueShield of Texas
U T SELECT Enrollment Guide
- BlueCross BlueShield of Texas
UT SELECT Home Delivery Service Form
- Medco Health
UT SELECT Prescription Claim Form
- Medco Health
Dental
Assurant Dental HMO Benefit Guide
- Assurant Employee Benefits
Assurant Dental Evidence of Coverage
- Assurant Employee Benefits
U T DENTAL SELECT Benefits Guide
- Delta Dental
U T DENTAL SELECT Claim Form
- Delta Dental
U T DENTAL SELECT Brochure
- Delta Dental
Vision
Superior Vision Benefits Guide
Superior Vision Benefits Summary
Superior Vision Provider Nomination Form
Superior Vision Brochure
U T FLEX
U T FLEX Benefits Guide
- PayFlex Systems
Grace Period Questions and Answers
PayFlex Direct Deposit Authorization Form
- PayFlex Systems
PayFlex Give Yourself A Pay Raise! Brochure
- PayFlex Systems
PayFlex Letter of Medical Necessity Form
- PayFlex Systems
UT FLEX Claim Form
- PayFlex Systems
Life & Accidental Death and Dismemberment (AD&D)
Group Term Benefits Guide
- Fort Dearborn Life
Accidental Death & Dismemberment Benefits Guide
- Fort Dearborn Life
Fort Dearborn Life / PAI Brochure
- Fort Dearborn Life Insurance
Fort Dearborn Life Beneficiary Designation Form
- Fort Dearborn Life Insurance
Short Term and Long Term Disability
Long Term Disability Benefits Guide
- CNA/Hartford
Short Term Disability Benefits Guide
- CNA/Hartford
Short Term Disability FAQs
- CNA/Hartford
Long Term Care
Long Term Care Brochure
- CNA/Hartford
Other
Benefits Cost Worksheet
Transitional Benefits Form
Change In Status Form For Mid-Year Benefit Election Changes
Chapter 1601 of the Texas Insurance Code
Coverage For Incapacitated Child Form
EGI Organizational Chart
HIPAA Privacy Information
HIPAA Security of Electronic Protected Health Information(PHI) COMPLIANCE MANUAL
