Page title

Forms and Publications

Main page content

Medical
Document Office Publish Date File
UT CONNECT Wellness Guidelines Employee Benefits UT CONNECT Wellness Guidelines Perinatal 2021-2022
UT CONNECT Wellness Guidelines Child 2021-2022
UT CONNECT Wellness Guidelines Adult 2021-2022
UT CARE Medicare Enrollment Brochure Employee Benefits UT CARE Medicare Enrollment Brochure
How to Log in to My UT Benefits for Retirees Employee Benefits How to Log in to My UT Benefits for Retirees
Annual Enrollment Medical Plans Highlights Employee Benefits 2022 Annual Enrollment Medical Plans Highlights for Employees & Retirees
Know Your Behavioral Health Network Employee Benefits UT SELECT Know Your Behavioral Health Network
UT CONNECT Know Your Behavioral Health Network
UT SELECT Health Advocate at BCBSTX Employee Benefits UT SELECT Health Advocate at BCBSTX
UT CARE Eligibility Flow Chart Employee Benefits UT CARE Eligibility Flow Chart
UT SELECT MDLIVE: How to Register Employee Benefits UT SELECT MDLIVE: Register today so you’re ready when you need care
UT CARE Medicare Plan in Other Languages Employee Benefits UT CARE Medicare Plan in Other Languages
UT CARE Medicare Welcome Letter Employee Benefits UT CARE Medicare Welcome Letter
UT CARE Eligibility Groups Employee Benefits UT CARE Eligibility Groups
UT SELECT Tobacco Cessation Program Employee Benefits UT SELECT Tobacco Cessation Program
24/7 Nurseline Employee Benefits 24/7 Nurseline
Tobacco Premium Program Declaration Form Employee Benefits Tobacco Premium Program Declaration Form
Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Employee Benefits Tobacco Cessation Program Physician Statement
Seasons of Life Employee Benefits UT SELECT Seasons of Life Brochure
UT SELECT Seasons of Life Presentation
UT CONNECT Seasons of Life Brochure
UT CONNECT Seasons of Life Presentation
UT CONNECT ACO Benefits Summary Chart Employee Benefits UT CONNECT ACO Benefits Summary Chart 2020-2021
UT CONNECT ACO Benefits Summary Chart 2019-2020
UT CONNECT Highlights Brochure Employee Benefits UT CONNECT Highlights Brochure 2021-2022
UT CONNECT Highlights Brochure 2020-2021
UT SELECT Ovia Health Overview Employee Benefits UT SELECT Ovia Health General Overview
UT SELECT Ovia Health Support for LGBTQ Families
UT SELECT Ovia Health Maternity App
UT SELECT Livongo Overview & FAQs Employee Benefits NEW! Livongo Overview Flyer 2021-2022
NEW! Livongo Overview Poster 2021-2022
NEW! Livongo Diabetes Management FAQs 2021-2022
NEW! Livongo Hypertension FAQs 2021-2022
Livongo Brochure 2020
Livongo Hypertension Brochure 2020
Livongo FAQs
UT SELECT Omada Health Overview Employee Benefits NEW! Omada Health Flyer 2021
NEW! Omada Health FAQs 2021
Omada Health Brochure 2020
Omada Health FAQs 2020
UT SELECT Hinge Health Overview Employee Benefits Hinge Health FAQs 2021-2022
Hinge Health Highlights 2021-2022
Hinge Health Brochure 2020
Hinge Health Enrollment 2020
UT SELECT Medical Claim Form Employee Benefits UT SELECT Medical Claim Form
Glossary of Health Coverage and Medical Terms Employee Benefits Uniform Glossary of Health Coverage and Medical Terms
UT CONNECT Ovia Health Overview Employee Benefits UT CONNECT Ovia Health Overview
UT CONNECT Ovia Health Maternity App
UT CONNECT Ovia Health Support for LGBTQ Families
UT CONNECT Ovia Health Mental Health Support
UT CONNECT Benefit Chart Comparison Employee Benefits UT CONNECT Benefit Chart Comparison 2022-2023
UT CONNECT Benefit Chart Comparison 2021-2022
PPO Network Summary of Benefits and Coverage Employee Benefits NEW! 2023-2024 Summary of Benefits: PPO Plan
NEW! 2023-2024 Summary of Benefits: PPO Plan (Spanish/Español)
2022-2023 Summary of Benefits: PPO Plan
2022-2023 Summary of Benefits: PPO Plan (Spanish/Español)
UT SELECT Benefits Summary Chart Employee Benefits UT SELECT Benefits Summary Chart 2022-2023
UT SELECT Benefits Summary Chart 2021-2022
UT CONNECT ACO Network Summary of Benefits and Coverage Employee Benefits 2022-2023 Summary of Benefits: UT CONNECT ACO Plan
2022-2023 Summary of Benefits: UT CONNECT ACO Plan (Spanish/Español)
UT Health Network Flyer Employee Benefits UT Health Network Flyer 2022
UT CONNECT ACO Medical Plan Guide with Prescription Drug Coverage Employee Benefits 2022-2023 UT CONNECT ACO Medical Plan Guide
2021-2022 UT CONNECT ACO Medical Plan Guide
UT CONNECT ACO Medical Plan FAQs Employee Benefits UT CONNECT FAQs 2022-2023
UT CARE Quick Start Reference Sheet Employee Benefits UT CARE Quick Start Reference Sheet
UT SELECT Health Advocacy Solutions Employee Benefits UT SELECT Health Advocacy Solutions 2023
BCBSTX Health Advocacy Solutions: Social Determinants of Health 2023
Airrosti Brochure Employee Benefits Fix Pain Fast
Complimentary Virtual Injury & Pain (VIP) Chat with a Provider
UT SELECT Blue Access for Members Employee Benefits UT SELECT Blue Access for Members 2023
BCBSTX Behavioral Health: Substance Abuse Employee Benefits BCBSTX Behavioral Health: Substance Abuse Flyer
UT SELECT Health Advocate Solutions FAQs Employee Benefits UT SELECT Health Advocate Solutions FAQs
UT CARE Medicare Plan: Ease into Medicare Employee Benefits UT CARE Medicare Plan: Ease into Medicare
UT CARE Medicare Highlights Employee Benefits UT CARE Medicare Highlights
UT CARE Medicare Importance of Part A and B Employee Benefits UT CARE: The importance of enrolling in Medicare Part A and Part B
BCBSTX Annual Wellness Checklist Employee Benefits BCBSTX Annual Wellness Checklist for UT Benefits Members
UT SELECT Health Advocate Solutions Infographic Employee Benefits UT SELECT Health Advocate Solutions Infographic
Learn to Live Resources for Your Mental Wellbeing Employee Benefits UT SELECT Learn to Live Resources for Your Mental Wellbeing 2023
Progyny Fertility Benefits Brochure & Member Guide Employee Benefits Progyny Fertility Benefits Overview
Progyny Fertility Member Guide
UT CARE Medicare Plan Providers and Network Employee Benefits UT CARE Medicare Plan Providers and Network
UT SELECT Benefits at a Glance Brochure Employee Benefits NEW! 2023-2024 UT SELECT Benefits At-a-Glance Brochure
2022-2023 UT SELECT Benefits At-a-Glance Brochure
J-Visa Summary of Benefits and Coverage Employee Benefits NEW! 2023-2024 Summary of Benefits: J-Visa Plan
NEW! 2023-2024 Summary of Benefits: J-Visa Plan (Spanish/Español)
2022-2023 Summary of Benefits: J-Visa Plan
2022-2023 Summary of Benefits: J-Visa Plan (Spanish/Español)
Out-of-Area Network Summary of Benefits and Coverage Employee Benefits NEW! 2023-2024 Summary of Benefits: Out-of-Area Plan
NEW! 2023-2024 Summary of Benefits: Out-of-Area Plan (Spanish/Español)
2022-2023 Summary of Benefits: Out-of-Area Plan
2022-2023 Summary of Benefits: Out-of-Area Plan (Spanish/Español)
UT SELECT Medical Plan Guide with Prescription Drug Coverage Employee Benefits NEW! 2023-2024 UT SELECT Benefits Guide
2022-2023 UT SELECT Benefits Guide
UT CARE Medicare Sample Enrollment Kit Employee Benefits UT CARE Medicare Sample Enrollment Kit
UT CARE Medicare Kit de Inscripción (en Español)
UT SELECT MDLIVE Overview Employee Benefits UT SELECT MDLIVE Brochure 2024
Preventive Services for Adults Employee Benefits Adult Wellness Guidelines
Preventive Services for Children Employee Benefits Wellness Guidelines for Children
Preventive Services for All Ages Employee Benefits Family Wellness and Preventive Care
Perinatal Wellness Guidelines Employee Benefits Recommendations for a Healthy Pregnancy
Pharmacy
Document Office Publish Date File
Express Scripts 90-Day Supply Employee Benefits Express Scripts: Relax with 90-day Supplies
UT SELECT Part D Language Services UT SELECT Part D Language Services
UT SELECT Part D Mail Order Form UT SELECT Part D Mail Order Form
UT SELECT Part D Presentation UT SELECT Part D Presentation
UT CARE Part D Contacts Employee Benefits UT CARE Part D Contacts
Prescriptions by Mail Order Form Employee Benefits Prescriptions by Mail Order Form
Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form Employee Benefits Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form
UT SELECT Part D Evidence of Coverage Employee Benefits UT SELECT Part D Evidence of Coverage
UT CARE Part D Welcome Kit Employee Benefits 2023 UT CARE Part D Welcome Kit
UT CARE Part D Benefit Overview Employee Benefits 2023 UT CARE Part D Benefit Overview
Getting Started with Home Delivery from Express Scripts Pharmacy Employee Benefits Getting Started with Home Delivery from Express Scripts Pharmacy
Prescription Drug Co-payments at a Glance Employee Benefits NEW! UT SELECT Prescription Drug Program at-a-Glance 2023-2024
UT SELECT Prescription Drug Program at-a-Glance 2022-2023
UT CARE Medicare Part D Prescription Drug Program at-a-Glance 2023
Express Scripts Print and Digital ID Cards Employee Benefits Express Scripts Print and Digital ID Cards
Express Scripts: Manage Your Prescription Plan Employee Benefits Express Scripts: Manage Your Prescription Plan
Accredo Specialty Pharmacy Employee Benefits Accredo Specialty Pharmacy Flyer
Express Scripts: How to Register Online Employee Benefits Express Scripts: How to Register Online
UT CARE Part D Welcome Kit Letter Employee Benefits 2024 UT CARE Part D Welcome Kit Letter
UT CARE Part D Formulary Employee Benefits 2024 UT CARE Part D Formulary
Dental
Document Office Publish Date File
DeltaCare Description of Benefits & Highlights Employee Benefits DeltaCare Description of Benefits & Highlights
UT SELECT DENTAL Claim Form Employee Benefits UT SELECT DENTAL Claim Form
DeltaCare Benefits Guide Employee Benefits 2022-2023 DeltaCare Benefits Guide
Delta Dental Support with LifePerks Employee Benefits Delta Dental Savings with LifePerks
Delta Dental Features with LifePerks
UT SELECT DENTAL Plus Highlights Employee Benefits NEW! UT SELECT DENTAL Plus Highlights 2023-2024
UT SELECT DENTAL Plus Highlights 2022-2023
DeltaCare Highlights Employee Benefits NEW! DeltaCare Highlights 2023-2024
DeltaCare Highlights 2022-2023
Delta Dental Support for Chronic Conditions Employee Benefits Delta Dental Support for Chronic Conditions with SmileWay
Your Dental Plan Options Employee Benefits Dental Plan Options: Compare Our Plans
UT SELECT DENTAL Highlights Employee Benefits NEW! UT SELECT DENTAL Highlights 2023-2024
UT SELECT DENTAL Highlights 2022-2023
Delta Dental Manage Your Plan Online Employee Benefits Delta Dental: Go online to manage your plan
UT SELECT DENTAL Benefits Guide Employee Benefits 2023-2024 UT SELECT DENTAL Benefits Guide
2022-2023 UT SELECT DENTAL Benefits Guide
UT SELECT DENTAL Plus Benefits Guide Employee Benefits 2023-2024 UT SELECT DENTAL Plus Benefits Guide
2022-2023 UT SELECT DENTAL Plus Benefits Guide
Vision
Document Office Publish Date File
Superior Vison Claim Form Employee Benefits Superior Vison Claim Form
Smart Alert - Partnering for Total Wellness Employee Benefits Superior Vision Smart Alert
Superior Vision Plan Brochure Employee Benefits Superior Vision Plan Brochure
Quality LASIK for Texas Members Employee Benefits Quality LASIK for Texas Members
Superior Vision Standard Benefits Guide Employee Benefits Superior Vision Basic Plan Certificate
Superior Vision Plan Amendment (eff. 9/1/2017)
Superior Vision Plus Benefits Guide Employee Benefits Superior Vision Plus Plan Certificate
Superior Vision Plan Amendment (eff. 9/1/2017)
Superior Vision Online Retailers Employee Benefits Superior Vision Online Contacts and Lenses Retailers
Superior Vision Mobile App Employee Benefits Superior Vision Mobile App 2022
Tips Caring for your Eyes Wearing Contacts Employee Benefits Tips for Caring for your Eyes While Wearing Contacts
Superior Vision: Getting Started with the Online Member Portal Employee Benefits Superior Vision Online Member Portal
The Importance of an Eye Exam Employee Benefits Superior Vision: The Importance of an Eye Exam
Superior Vision: Laser Vision Correction (LASIK) Employee Benefits Superior Vision: Laser Vision Correction (LASIK)
Superior Vision Plan Highlights Employee Benefits NEW! Superior Vision Highlights 2023-2024
Superior Vision Highlights 2022-2023
Finding-In-Network Providers Employee Benefits Find an In-Network Eye Care Professional 2023
Superior Vision Member Discounts Employee Benefits Superior Vision Member Discounts
Superior Vision Member Hearing Network Discount
Special Notices
Document Office Publish Date File
HIPAA Request for Confidential Communications of Medical Information Employee Benefits HIPAA Request for Confidential Communications of Medical Information Form
HIPAA Request for Restriction on Use or Disclosure of Protected Health Information Employee Benefits HIPAA Request for Restriction Form
HIPAA Breach Log Employee Benefits HIPAA Breach Log
HIPAA Request for Amendment of Protected Health Information Employee Benefits HIPAA Request for Amendment of Protected Health Information Form
HIPAA Request for Access to Protected Health Information Employee Benefits Request for Access Form
HIPAA Complaint Form Employee Benefits HIPAA Complaint Form
HIPAA Request for Accounting of Disclosures Employee Benefits HIPAA Request for Accounting of Disclosues Form
HIPAA Staff Assistance Authorization Employee Benefits HIPAA Staff Assistance Authorization
HIPAA Revocation of Authorization Employee Benefits HIPAA Revocation of Authorization Form
HIPAA General Authorization Form Employee Benefits HIPAA General Authorization Form
BAC By-Laws Employee Benefits BAC By-laws
Nondiscrimination and Accessibility Notice Employee Benefits Nondiscrimination and Accessibility Notice
Medicaid and the Children's Health Insurance Program (CHIP) Notice Employee Benefits Medicaid and the Children's Health Insurance Program (CHIP) Notice
Notice of Creditable Coverage (NOCC) Employee Benefits Medicare Part D Notice of Creditable Coverage
Legal Notices Employee Benefits UT Benefits - Legal Notices 2023 (effective September 1, 2023)
UT Benefits - Legal Notices 2022
Affordable Care Act - Marketplace Notices Employee Benefits Stephen F Austin State University ACA Notice
UT Arlington ACA Notice
UT Austin ACA Notice
UT Dallas ACA Notice
UT El Paso ACA Notice
UT Health Houston ACA Notice
UT Health San Antonio ACA Notice
UT Health Tyler ACA Notice
UT Medical Branch Galveston ACA Notice
UT MD Anderson Cancer Center ACA Notice
UT Permian Basin ACA Notice
UT Rio Grande Valley ACA Notice
UT San Antonio ACA Notice
UT Southwestern Medical Center ACA Notice
UT System Administration ACA Notice
UT Tyler ACA Notice
UT Retirement Program
Document Office Publish Date File
ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE Employee Benefits ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE
UT Transfer Verification Form (All plans) Employee Benefits UT Transfer Verification Form (All plans)
ORP Authorization for Reduction for Employee Contribution Employee Benefits ORP Authorization for Reduction for Employee Contribution
DCP Catch-Up Provision Agreement Employee Benefits DCP Catch-Up Provision Agreement
UTSaver TSA Disclosure Form Employee Benefits UTSaver TSA Disclosure Form
ORP Acknowledgement Employee Benefits ORP Acknowledgement
Vesting/Termination Status Form Employee Benefits Vesting/Termination Status Form
TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund) Employee Benefits TRS Form 28 (Oct 2019)
Retirement Program Sales Solicitation Agreement Employee Benefits Retirement Program Sales Solicitation Agreement
Overview of TRS and ORP Employee Benefits TRS and ORP Overview - July 2021
UTSaver Loan and Inservice Distribution Options Employee Benefits UTSaver Loan and Inservice Distribution Options
Weathering the Storm Employee Benefits Weathering the Storm
Annual Leave Deferral Agreement Employee Benefits Annual Leave Deferral Agreement
Purchase Change Agreement (All plans) Employee Benefits UT Retirement Purchase Change Agreement (All plans)
Annual Eligibility Notice for Retirement Plans Employee Benefits Annual Eligibility Notice for Retirement Plans
Vendor Services Employee Benefits Vendor Services for Retirement Participants
Summary of Retirement Programs Employee Benefits Retirement Programs Summary
Voluntary Retirement Programs At a Glance Employee Benefits Voluntary Retirement Programs
Comparison of Traditional, Roth 403(b), and Roth IRA Contributions Employee Benefits Comparison of Traditional, Roth 403(b), and Roth IRA Contributions
Benefits Handbooks and Cost Worksheet
Document Office Publish Date File
Annual Enrollment & Resource Guide for Retired Employees Employee Benefits NEW! 2023-2024 Annual Enrollment & Resource Guide for Retired Employees
2022-2023 Annual Enrollment & Resource Guide for Retired Employees
Annual Enrollment & Resource Guide for Employees Employee Benefits NEW! 2023-2024 Annual Enrollment & Resource Guide for Employees
2022-2023 Annual Enrollment & Resource Guide for Employees
Annual Enrollment Highlights for Employees Employee Benefits NEW! 2023-2024 Annual Enrollment Highlights for Employees
2022-2023 Annual Enrollment Highlights for Employees
Annual Enrollment Highlights for Retired Employees Employee Benefits NEW! 2023-2024 Annual Enrollment Highlights for Retired Employees
2022-2023 Annual Enrollment Highlights for Retired Employees
Benefits Cost Worksheet for Employees Employee Benefits 2023-2024 Active Employee Cost Worksheet
2022-2023 Active Employee Cost Worksheet
Benefits Cost Worksheet for Retired Employees Employee Benefits 2023-2024 Retired Employee Cost Worksheet
2022-2023 Retired Employee Cost Worksheet
UT Benefits Enrollment Guide for Retiring Employees Employee Benefits 2023-2024 UT Benefits Enrollment Guide for Retiring Employees
2022-2023 UT Benefits Enrollment Guide for Retiring Employees
UT Benefits Enrollment Guide for Employees Employee Benefits NEW! 2023-2024 UT Benefits Enrollment Guide for Employees
2022-2023 UT Benefits Enrollment Guide for Employees
Other
Document Office Publish Date File
Welcome Letter for SFA Members Employee Benefits Welcome Letter for SFA Members (June 9, 2023)
Wondr Health Program Employee Benefits Wondr Health Program (formerly Naturally Slim)
UT Living Well FAQs for Stephen F. Austin State University Employee Benefits UT Living Well FAQs for SFA University Members
SilverSneakers Tuition Rewards Flyer Employee Benefits SilverSneakers Tuition Rewards Flyer
SilverSneakers Tuition Rewards Flyer (Español)
UT Retirement FAQs for Stephen F. Austin State University Employee Benefits UT Retirement FAQs for SFA University Members
UT System Cafeteria Plan Document Employee Benefits UT System Cafeteria Plan Document
Grandchild Certification Form Employee Benefits Dependent Grandchild Certification Form
BCBSTX Identity Protection Services Employee Benefits BCBSTX Identity Protection Services
COBRA General Notice Employee Benefits COBRA General Notice for the 2022-2023 Plan Year
Living Well Resources Guide Employee Benefits Living Well Resources Guide 2023-2024
SFA Benefits Comparison Employee Benefits SFA Benefits Comparison for Employees and Retirees
Living Well Platform How to Guide Employee Benefits Living Well Platform How to Guide
Benefits Coverage Mapping for SFA Employees & Retirees Employee Benefits Benefits Coverage Mapping for SFA Employees
Benefits Coverage Mapping for SFA Retirees
Insurance FAQs for Stephen F. Austin State University Employee Benefits Insurance FAQs for SFA University Members
COBRA Rates Employee Benefits COBRA Rates 2023-2024
COBRA Rates 2022-2023
COBRA Application FAQs Employee Benefits COBRA Application FAQs 2023-2024
Enrolling as a New Hire During Annual Enrollment Employee Benefits Enrolling as a New Hire During Annual Enrollment
Blue Cross and Blue Shield of Texas Fitness Program Employee Benefits BCBSTX Fitness Program for UT SELECT 2024
Office of Employee Benefits Organizational Chart Employee Benefits Office of Employee Benefits Organizational Chart
Retirement Plan Publications
Document Office Publish Date File
Logging Into Retirement Manager Employee Benefits Logging Into Retirement Manager
UT Retirement Vendor Engagement Portfolio Employee Benefits UT Retirement Vendor Engagement Portfolio
UT CARES Act Employee Benefits UT CARES Act
Fidelity Investments Information Employee Benefits Fidelity Investments Mobile App 2021
Fidelity Investments Fact Sheet 2022
Ways to Work with Fidelity Investments: Call, Click, or Visit
Enroll in UT Retirement with Fidelity Investments
Getting Started with your Fidelity Account
Voya Financial Information Employee Benefits Voya Financial: Brochure 2023
Voya Financial: UTSaver 457(b) Deferred Compensation Plan
Voya Financial: 11 Ways to Keep your Cool in a Crazy Market
Voya Financial: The Cost of Waiting
Voya Financial: Managing Key Risks to Make Your Retirement Income Last
Voya Financial: Retiring? It’s time to make a few decisions
Voya Financial: 2023 Webinars
TIAA Information Employee Benefits NEW! TIAA Benefit of Starting Now
NEW! TIAA Benefits of One Percent
TIAA Diversification and Market Volatility
TIAA Staying on Track
Lincoln Financial Information Employee Benefits 2023 Lincoln Financial Group Brochure
2023 Lincoln Financial Group Plan Representative & Support
Lincoln Financial: Register for online account access
Understanding the UT Optional Retirement Program (ORP)
Lincoln Financial: Financial Wellness Matters
Lincoln Financial: Review your Beneficiaries Today
UTSaver Retirement Plans Brochure Employee Benefits 2023-2024 UTSaver Retirement Plans: The Best Start
Corebridge Financial Retirement Services Information Employee Benefits Corebridge Retirement Services Highlights
Corebridge: Double Your Tax-Deferred Retirement Savings
Corebridge: Could a Roth 457(b) Fit in your Future?