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Publications are communication focused documents, booklets, forms and references. The focus of these documents are to relay helpful information about the UT System, employee benefit information, campuses facts and more.

May 2019
Title Published Office File(s) Page
Record of Revisions Employee Benefits Record of Revisions More Info on Record of Revisions
April 2019
Title Published Office File(s) Page
Annual Eligibility Notice for Retirement Plans Employee Benefits Annual Eligibility Notice for Retirement Plans More Info on Annual Eligibility Notice for Retirement Plans
March 2019
Title Published Office File(s) Page
UT System SmartBook Institutional Research and Analysis SmartBook March 2019 More Info on UT System SmartBook
February 2019
Title Published Office File(s) Page
Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Employee Benefits Tobacco Cessation Program Physician Statement More Info on Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program
Tobacco Premium Program Declaration Form Employee Benefits Tobacco Premium Program Declaration Form More Info on Tobacco Premium Program Declaration Form
January 2019
Title Published Office File(s) Page
Trip Cancellation Claim Form Risk Management 2019 Trip Cancellation Claim Form More Info on Trip Cancellation Claim Form
Claim Reporting Instructions Risk Management 2019 Claim Reporting Instructions More Info on Claim Reporting Instructions
UT ISOS ID Card Risk Management UT ISOS ID Card 2019 More Info on UT ISOS ID Card
Medical Claim Form Risk Management 2019 Medical Claim Form More Info on Medical Claim Form
Office of Employee Benefits Organizational Chart Employee Benefits Office of Employee Benefits Organizational Chart More Info on Office of Employee Benefits Organizational Chart
December 2018
Title Published Office File(s) Page
UT CONNECT ACO Benefits Summary Chart Employee Benefits UT CONNECT ACO Benefits Summary Chart 2018-2019 More Info on UT CONNECT ACO Benefits Summary Chart
UT Benefits Enrollment Guide for Employees Employee Benefits UT Benefits Enrollment Guide for Employees 2017-2018
UT Benefits Enrollment Guide for Employees 2018-2019 		More Info on UT Benefits Enrollment Guide for Employees
UT Benefits Enrollment Guide for Retiring Employees Employee Benefits UT Benefits Enrollment Guide for Retiring Employees 2017-2018
UT Benefits Enrollment Guide for Retiring Employees 2018-2019 		More Info on UT Benefits Enrollment Guide for Retiring Employees
Summary of Retirement Programs Employee Benefits Retirement Programs Summary More Info on Summary of Retirement Programs
Comparison of Traditional, Roth 403(b), and Roth IRA Contributions Employee Benefits Comparison of Traditional, Roth 403(b), and Roth IRA Contributions More Info on Comparison of Traditional, Roth 403(b), and Roth IRA Contributions
Voluntary Retirement Programs At a Glance Employee Benefits Voluntary Retirement Programs More Info on Voluntary Retirement Programs At a Glance
UT System Administration Standards of Conduct Guide Systemwide Compliance UT System Administration Standards of Conduct Guide More Info on UT System Administration Standards of Conduct Guide
October 2018
Title Published Office File(s) Page
UT Benefits Billing Direct Payment/Debit Authorization Agreement Employee Benefits Direct Payment/Debit Authorization Agreement More Info on UT Benefits Billing Direct Payment/Debit Authorization Agreement
UT Benefits Billing for COBRA Direct Payment/Debit Authorization Agreement Employee Benefits UT Benefits Billing for COBRA Direct Payment/Debit Authorization Agreement More Info on UT Benefits Billing for COBRA Direct Payment/Debit Authorization Agreement
September 2018
Title Published Office File(s) Page
UT FLEX Benefits Guide Employee Benefits UT FLEX Benefits Guide 2017-2018
UT FLEX Benefits Guide 2018-2019 		More Info on UT FLEX Benefits Guide
UT SELECT DENTAL Benefits Guide Employee Benefits UT SELECT DENTAL Benefits Guide 2017-2018
UT SELECT DENTAL Benefits Guide 2018-2019 		More Info on UT SELECT DENTAL Benefits Guide
UT SELECT DENTAL Plus Benefits Guide Employee Benefits UT SELECT DENTAL Plus Benefits Guide 2017-2018
UT SELECT DENTAL Plus Benefits Guide 2018-2019 		More Info on UT SELECT DENTAL Plus Benefits Guide
UT SELECT Benefits Summary Chart Employee Benefits UT SELECT Benefits Summary Chart 2017-2018
UT SELECT Benefits Summary Chart 2018-2019 		More Info on UT SELECT Benefits Summary Chart
COBRA Rates Employee Benefits COBRA Rates 2018-2019 More Info on COBRA Rates
COBRA General Notice Employee Benefits COBRA General Notice for the 2017-2018 Plan Year
COBRA General Notice for the 2018-2019 Plan Year 		More Info on COBRA General Notice
COBRA Application FAQs Employee Benefits COBRA Application FAQs More Info on COBRA Application FAQs
701. Premium Billing & Remittance Employee Benefits Premium Billing & Remittance More Info on 701. Premium Billing & Remittance
UT SELECT Medical Plan Guide with Prescription Drug Coverage Employee Benefits 2017-2018 UT SELECT Benefits Guide
2018-2019 UT SELECT Benefits Guide 		More Info on UT SELECT Medical Plan Guide with Prescription Drug Coverage
Fast Facts September 2018 Institutional Research and Analysis Fast Facts September 2018 More Info on Fast Facts September 2018
Prescriptions by Mail Order Form Employee Benefits Prescriptions by Mail Order Form More Info on Prescriptions by Mail Order Form
UT Health Network Flyer Employee Benefits UT Health Network Flyer 2017-2018
UT Health Network Flyer 2018-2019 		More Info on UT Health Network Flyer
August 2018
Title Published Office File(s) Page
Operating Budget Rules Controller FY 2019
FY 2018
FY 2017
FY 2016 Revised 		More Info on Operating Budget Rules
DCP Purchase Agreement Employee Benefits DCP Purchase Agreement More Info on DCP Purchase Agreement
July 2018
Title Published Office File(s) Page
Legal Notices Employee Benefits UT Benefits - Legal Notices 2017
UT Benefits - Legal Notices 2018 		More Info on Legal Notices
Medicaid and the Children's Health Insurance Program (CHIP) Notice Employee Benefits Medicaid and the Children's Health Insurance Program (CHIP) Notice More Info on Medicaid and the Children's Health Insurance Program (CHIP) Notice
HIPAA Notice of Privacy Practices Employee Benefits HIPAA Notice of Privacy Practices 2017
HIPAA Notice of Privacy Practices 2018 		More Info on HIPAA Notice of Privacy Practices
Glossary of Health Coverage and Medical Terms Employee Benefits Glossary of Health Coverage and Medical Terms More Info on Glossary of Health Coverage and Medical Terms
UT CONNECT ACO Medical Plan FAQs Employee Benefits UT CONNECT-faqs-2018-2019 More Info on UT CONNECT ACO Medical Plan FAQs
Out-of-Area Network Summary of Benefits and Coverage Employee Benefits 2018-2019 Summary of Benefits and Coverage: Out-of-Area Plan
2018-2019 Summary of Benefits and Coverage: Out-of-Area Plan (Spanish/Español) 		More Info on Out-of-Area Network Summary of Benefits and Coverage
PPO Network Summary of Benefits and Coverage Employee Benefits 2018-2019 Summary of Benefits Summary: PPO Plan
2018-2019 Summary of Benefits Summary: PPO Plan (Spanish/Español) 		More Info on PPO Network Summary of Benefits and Coverage
MyEvive Registration Instructions Employee Benefits MyEvive Registration Instructions More Info on MyEvive Registration Instructions
MyEvive FAQs Employee Benefits MyEvive FAQs More Info on MyEvive FAQs
Annual Enrollment & Resource Guide for Retired Employees for 2018-2019 Employee Benefits 2018-2019 Annual Enrollment & Resource Guide for Retired Employees More Info on Annual Enrollment & Resource Guide for Retired Employees for 2018-2019
Benefits Cost Worksheet for Employees 2018-2019 Employee Benefits Active Employee Cost Worksheet 2018-2019 More Info on Benefits Cost Worksheet for Employees 2018-2019
Annual Enrollment & Resource Guide for Employees for 2018-2019 Employee Benefits 2018-2019 Annual Enrollment & Resource Guide for Employees More Info on Annual Enrollment & Resource Guide for Employees for 2018-2019
Benefits Cost Worksheet for Retired Employees 2018-2019 Employee Benefits Retired Employee Cost Worksheet 2018-2019 More Info on Benefits Cost Worksheet for Retired Employees 2018-2019
June 2018
Title Published Office File(s) Page
121. Benefits Advisory Committee Employee Benefits Benefits Advisory Committee More Info on 121. Benefits Advisory Committee
April 2018
Title Published Office File(s) Page
HUB Annual Report 2017 & Supplemental Letter Historically Underutilized Business FY 2017 720_cons (2).pdf
FY 2017 SL 720.pdf 		More Info on HUB Annual Report 2017 & Supplemental Letter
March 2018
Title Published Office File(s) Page
574. Institution-based Voluntary Plans Employee Benefits Institution-based Voluntary Plans More Info on 574. Institution-based Voluntary Plans
February 2018
Title Published Office File(s) Page
Budget Preparation Policies Controller FY 2019
FY 2018
FY 2017
FY 2016 		More Info on Budget Preparation Policies
January 2018
Title Published Office File(s) Page
ACORD Automobile Loss Notice Risk Management 2017 Auto Loss Notice More Info on ACORD Automobile Loss Notice
December 2017
Title Published Office File(s) Page
Retirement Eligibility Flowchart Employee Benefits Retirement Eligibility Flowchart More Info on Retirement Eligibility Flowchart
November 2017
Title Published Office File(s) Page
Voluntary Retirement Programs Loan and Hardship Options Employee Benefits Voluntary Retirement Programs Loan and Hardship Options More Info on Voluntary Retirement Programs Loan and Hardship Options
September 2017
Title Published Office File(s) Page
STD Benefit Highlights Employee Benefits STD Benefit Highlights More Info on STD Benefit Highlights
Long-Term Disability Benefit Highlights Employee Benefits LTD Benefit Highlights 2017.pdf More Info on Long-Term Disability Benefit Highlights
Required Documentation for Eligible Dependents Chart Employee Benefits Required Documentation for Eligible Dependents Chart More Info on Required Documentation for Eligible Dependents Chart
250. COBRA Participants Employee Benefits COBRA More Info on 250. COBRA Participants
310. Qualified Status Change Events Employee Benefits Change in Status More Info on 310. Qualified Status Change Events
570. UT FLEX Program Employee Benefits UT FLEX Program More Info on 570. UT FLEX Program
Introduction Employee Benefits Introduction to OEB Administrative Manual More Info on Introduction
Affordable Care Act - Marketplace Notices Employee Benefits 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 Northeast 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 		More Info on Affordable Care Act - Marketplace Notices
130. Office of Employee Benefits Terms and Definitions Employee Benefits Office of Employee Benefits Terms and Definitions More Info on 130. Office of Employee Benefits Terms and Definitions
210. Employees Employee Benefits Employee Eligibility and Enrollment More Info on 210. Employees
111. Uniform Insurance Benefits Act Employee Benefits Uniform Insurance Benefits Act More Info on 111. Uniform Insurance Benefits Act
140. Funding for Group Insurance Coverage Employee Benefits Funding for Group Insurance Coverage More Info on 140. Funding for Group Insurance Coverage
211. Certain Non-Employees Employee Benefits Certain Non-Employees More Info on 211. Certain Non-Employees
230. Dependents Employee Benefits Dependents More Info on 230. Dependents
240. Surviving Dependents Employee Benefits Surviving Dependents More Info on 240. Surviving Dependents
270. Evidence of Insurability (EOI) Employee Benefits Evidence of Insurability (EOI) More Info on 270. Evidence of Insurability (EOI)
707. Retroactive Eligibility Adjustments Employee Benefits Retroactive Eligibility Adjustments More Info on 707. Retroactive Eligibility Adjustments
120. Office of Employee Benefits Administration Employee Benefits Office of Employee Benefits Administration More Info on 120. Office of Employee Benefits Administration
220. Retired Employees Employee Benefits Retired Employee Eligibility and Enrollment More Info on 220. Retired Employees
August 2017
Title Published Office File(s) Page
Superior Vision Standard Benefits Guide Employee Benefits Superior Vision Standard Plan Certificate
Superior Vision Plan Amendment (eff. 9/1/2017) 		More Info on Superior Vision Standard Benefits Guide
Superior Vision Plus Benefits Guide Employee Benefits Superior Vision Plus Plan Certificate
Superior Vision Plan Amendment (eff. 9/1/2017) 		More Info on Superior Vision Plus Benefits Guide
July 2017
Title Published Office File(s) Page
Annual Enrollment & Resource Guide for Employees 2017-2018 Employee Benefits 2017-2018 Annual Enrollment & Resources Guide for Employees More Info on Annual Enrollment & Resource Guide for Employees 2017-2018
Annual Enrollment & Resource Guide for Retirees 2017-2018 Employee Benefits 2017-2018 Annual Enrollment & Resources Guide for Retirees More Info on Annual Enrollment & Resource Guide for Retirees 2017-2018
Benefits Cost Worksheet for Employees 2017-2018 Employee Benefits Active Employee Cost Worksheet 2017-2018 More Info on Benefits Cost Worksheet for Employees 2017-2018
Benefits Cost Worksheet for Retired Employees 2017-2018 Employee Benefits Retired Employee Cost Worksheet 2017-2018 More Info on Benefits Cost Worksheet for Retired Employees 2017-2018
June 2017
Title Published Office File(s) Page
Nondiscrimination and Accessibility Notice Employee Benefits Nondiscrimination and Accessibility Notice More Info on Nondiscrimination and Accessibility Notice
May 2017
Title Published Office File(s) Page
FY2017-2022_CIP_Quarterly_Update_May_2017 Facilities Planning and Construction FY2017-2022_CIP_Quarterly_Update_May_2017.pdf More Info on FY2017-2022_CIP_Quarterly_Update_May_2017