Publications by Office

Employee Benefits
DocumentPublish DateFile
111. Uniform Insurance Benefits ActUniform Insurance Benefits Act
120. Office of Employee Benefits Administration120administration.pdf
130. Office of Employee Benefits Terms and DefinitionsOffice of Employee Benefits Terms and Definitions
140. Funding for Group Insurance CoverageFunding for Group Insurance Coverage
141. Waiting Period for Group Insurance BenefitsWaiting Period for Group Insurance Benefits
142. Premium Sharing for Graduate Students and Part-Time EmployeesPremium Sharing for Graduate Students and Part-Time Employees
150. Program to Prevent, Detect & Mitigate Identity TheftProgram to Prevent, Detect & Mitigate Identity Theft
160. Tobacco Premium Program160tobaccopremiumprogram.pdf
210. EmployeesEmployee Eligibility and Enrollment
211. Certain Non-Employees211nonemployees.pdf
220. Retired EmployeesRetired Employee Eligibility and Enrollment
230. DependentsDependents
24/7 Nurseline24/7 Nurseline
240. Surviving Dependents240survivingdependents.pdf
250. COBRA Participants250cobra.pdf
260. Health Insurance Premium Payment (HIPP) Reimbursement Program260hipp.pdf
270. Evidence of Insurability (EOI)Evidence of Insurability (EOI)
310. Qualified Status Change EventsChange in Status
320. Active Military Duty320activemilitaryduty.pdf
400. Health Insurance Portability and Accountability Act (HIPAA)Health Insurance Portability and Accountability Act (HIPAA)
570. UT FLEX ProgramUT FLEX Program
571. UT FLEX Contribution ReportingUT FLEX Contribution Reporting
572. Address Change Procedures for UT FLEX Debit Card Participants572flexaddresschange.pdf
573. Annual Base Benefit Rate (ABBR) Calculation573abbrcalculation.pdf
701. Premium Billing & ReconciliationPremium Billing & Reconciliation
702. Billing of Postage to Components702postagebilling.pdf
705. Employee Assistance Program705eapcredit.pdf
706. BCBS Eligibility Audit706bcbseligaudit.pdf
707. Retroactive Eligibility Adjustments707retroeligadj.pdf
810. Optional Retirement Program810orp.pdf
820. UTSaver Tax-Sheltered Annuity Program820tsa.pdf
830. UTSaver Deferred Compensation Plan830dcp.pdf
840. Investment Policy StatementInvestment Policy Statement
About Online Beneficiary ManagementOnline Beneficiary Management
Accelerated Death Claim FormAccelerated Death Claim Form
Accidental Death & Dismemberment Benefits GuideAccidental Death & Dismemberment Benefits Guide
Accidental Dismemberment Claim FormAccidental Dismemberment Claim Form
Annual Eligibility Notice for Retirement PlansAnnual Eligibility Notice for Retirement Plans
Annual Enrollment & Resource Guide for Employees 2016-2017Annual Enrollment & Resource Guide for Employees 2016-2017
Annual Enrollment & Resource Guide for Employees 2017-20182017-2018 Annual Enrollment & Resources Guide for Employees
Annual Enrollment & Resource Guide for Retired Employees 2016-2017Annual Enrollment & Resource Guide for Retired Employees 2016-2017
Annual Enrollment & Resource Guide for Retirees 2017-20182017-2018 Annual Enrollment & Resources Guide for Retirees
BAC By-LawsBAC By-laws
Beneficiary Designation FormBeneficiary Designation Form
Benefits Cost Worksheet for Employee 2016-2017Benefits Cost Worksheet for Employee 2016-2017
Benefits Cost Worksheet for Employees 2017-2018Active Employee Cost Worksheet 2017-2018
Benefits Cost Worksheet for Retired Employee 2016-2017Benefits Cost Worksheet for Retired Employee 2016-2017
Benefits Cost Worksheet for Retired Employees 2017-2018Retired Employee Cost Worksheet 2017-2018
Benefits Overview for Employees 2016-2017Benefits Overview for Employees 2016-2017
Benefits Overview for Retired Employees 2016-2017Benefits Overview for Retired Employees 2016-2017
COBRA Application FAQsCOBRA Application FAQs
COBRA General NoticeCOBRA General Notice
Comparison of Traditional, Roth 403(b), and Roth IRA ContributionsComparison of Traditional, Roth 403(b), and Roth IRA Contributions
Create Your Own Will OnlineCreate Your Own Will Online
DCP Catch-Up Provision AgreementDCP Catch-Up Provision Agreement
DCP Purchase AgreementDCP Purchase Agreement
Death Claim FormDeath Claim Form
Delta Dental Online ServicesDelta Dental Online Services
DeltaCare - Getting the Most from Your Dental HMOGetting the Most from Your Dental HMO
DeltaCare Benefits GuideDeltaCare Benefits Guide