Publications

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.

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February 2017
Title Published Office File(s) Page
HIPAA General Authorization Form Employee Benefits HIPAA General Authorization Form More Info on HIPAA General Authorization Form
HIPAA Policy Section 4.2: Access to System PHI Employee Benefits HIPAA Policy Section 4.2: Access to System PHI More Info on HIPAA Policy Section 4.2: Access to System PHI
HIPAA Complaint Form Employee Benefits HIPAA Complaint Form More Info on HIPAA Complaint Form
HIPAA Privacy Officer Designation Employee Benefits HIPAA Privacy Officer Designation More Info on HIPAA Privacy Officer Designation
HIPAA Request for Access to Protected Health Information Employee Benefits Request for Access Form More Info on HIPAA Request for Access to Protected Health Information
HIPAA Request for Accounting of Disclosures Employee Benefits HIPAA Request for Accounting of Disclosues Form More Info on HIPAA Request for Accounting of Disclosures
Fast Facts 2016 Institutional Research and Analysis Fast Facts 2016
Fast Facts 2016 - Winter Update, Feb 2017 		More Info on Fast Facts 2016
March 2017
Title Published Office File(s) Page
BAC By-Laws Employee Benefits BAC By-laws More Info on BAC By-Laws
April 2017
Title Published Office File(s) Page
Quality LASIK for Texas Members Employee Benefits Quality LASIK for Texas Members More Info on Quality LASIK for Texas Members
Superior Vision Plan Brochure Employee Benefits Superior Vision Plan Brochure More Info on Superior Vision Plan Brochure
May 2017
Title Published Office File(s) Page
The University of Texas System Police Annual Report. 2016 Police Annual Report More Info on The University of Texas System Police Annual Report. 2016
The UT System Police Department Annual Contact Report - 2016 Police Racial Profiling Report 2016 More Info on The UT System Police Department Annual Contact Report - 2016
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
August 2017
Title Published Office File(s) Page
Superior Vision Standard Benefits Guide Employee Benefits Superior Vision Basic Plan Certificate
Superior Vision Plan Amendment (eff. 9/1/2017) 		More Info on Superior Vision Standard Benefits Guide
September 2017
Title Published Office File(s) Page
120. Office of Employee Benefits Administration Employee Benefits Office of Employee Benefits Administration More Info on 120. Office of Employee Benefits Administration
211. Certain Non-Employees Employee Benefits Certain Non-Employees More Info on 211. Certain Non-Employees
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
Introduction Employee Benefits Introduction to OEB Administrative Manual More Info on Introduction
111. Uniform Insurance Benefits Act Employee Benefits Uniform Insurance Benefits Act More Info on 111. Uniform Insurance Benefits Act
270. Evidence of Insurability (EOI) Employee Benefits Evidence of Insurability (EOI) More Info on 270. Evidence of Insurability (EOI)
December 2017
Title Published Office File(s) Page
Retirement Eligibility Flowchart Employee Benefits Retirement Eligibility Flowchart More Info on Retirement Eligibility Flowchart
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
April 2018
Title Published Office File(s) Page
HUB Annual Report 2017 & Supplemental Letter Historically Underutilized Business Annual Report
Supplemental Letter 		More Info on HUB Annual Report 2017 & Supplemental Letter
June 2018
Title Published Office File(s) Page
121. Benefits Advisory Committee Employee Benefits Benefits Advisory Committee More Info on 121. Benefits Advisory Committee
July 2018
Title Published Office File(s) Page
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
September 2018
Title Published Office File(s) Page
160. Tobacco Premium Program Employee Benefits Policy 160 Tobacco Premium Program More Info on 160. Tobacco Premium Program
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
Fast Facts Institutional Research and Analysis Fast Facts September 2018 More Info on Fast Facts
701. Premium Billing & Remittance Employee Benefits Premium Billing & Remittance More Info on 701. Premium Billing & Remittance
December 2018
Title Published Office File(s) Page
UT System Population Health Strategic Plan Population Health Population Health Strategic Plan More Info on UT System Population Health Strategic Plan
September 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
Personal Information and Emergency Contact Form Employee Benefits Personal Information and Emergency Contact Form More Info on Personal Information and Emergency Contact Form
October 2019
Title Published Office File(s) Page
TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund) Employee Benefits TRS Form 28 (Oct 2019) More Info on TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund)
December 2019
Title Published Office File(s) Page
Claim Reporting Instructions Risk Management CHUBB USA Claim Reporting Instructions 2020 More Info on Claim Reporting Instructions
Medical Claim Form Risk Management 2020 Medical Claim Form More Info on Medical Claim Form
Trip Cancellation Claim Form Risk Management 2020 Trip Cancellation Claim Form More Info on Trip Cancellation Claim Form
March 2020
Title Published Office File(s) Page
Death Claim Form Employee Benefits Death Claim Form More Info on Death Claim Form
LTD Employee Claim Form Employee Benefits LTD Employee Claim Form More Info on LTD Employee Claim Form
Life Portability Application Employee Benefits Life Portability Application More Info on Life Portability Application
Beneficiary Designation Form Employee Benefits Beneficiary Designation Form More Info on Beneficiary Designation Form
Accidental Dismemberment Claim Form Employee Benefits Accidental Dismemberment Claim Form More Info on Accidental Dismemberment Claim Form
Life Conversion Application Employee Benefits Application to Convert Group Life Insurance More Info on Life Conversion Application
LTD Employer Claim Form Employee Benefits LTD Employer Claim Form More Info on LTD Employer Claim Form
Life and AD&D Brochure for Active Employees Employee Benefits Life and AD&D Benefit Brochure for Active Employees More Info on Life and AD&D Brochure for Active Employees
Long-Term Disability Conversion Kit Employee Benefits Long Term Disability Conversion Kit More Info on Long-Term Disability Conversion Kit
April 2020
Title Published Office File(s) Page
HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report Historically Underutilized Business Instruction for Prime Contractor Progress Assessment Report
Progress Assessment Report (PAR) 		More Info on HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report
Section 55.03: FY 2017 Annual Report Historically Underutilized Business Report Summary
Report Detail
Report Contract Counts 		More Info on Section 55.03: FY 2017 Annual Report
June 2020
Title Published Office File(s) Page
Retirement Program Sales Solicitation Agreement Employee Benefits Retirement Program Sales Solicitation Agreement More Info on Retirement Program Sales Solicitation Agreement
July 2020
Title Published Office File(s) Page
UT System Cafeteria Plan Document Employee Benefits UT System Cafeteria Plan Document More Info on UT System Cafeteria Plan Document
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 		More Info on Seasons of Life
August 2020
Title Published Office File(s) Page
UT ISOS ID Card Risk Management UT ISOS Card 2020 More Info on UT ISOS ID Card
HUB Annual Report 2020 and Supplemental Letter Historically Underutilized Business Annual Report
Supplemental Letter 		More Info on HUB Annual Report 2020 and Supplemental Letter
September 2020
Title Published Office File(s) Page
240. Surviving Dependents Employee Benefits Surviving Dependents More Info on 240. Surviving Dependents
250. COBRA Participants Employee Benefits COBRA More Info on 250. COBRA Participants
210. Employees Employee Benefits Employee Eligibility and Enrollment More Info on 210. Employees
UT CONNECT ACO Benefits Summary Chart Employee Benefits UT CONNECT ACO Benefits Summary Chart 2020-2021
UT CONNECT ACO Benefits Summary Chart 2019-2020 		More Info on UT CONNECT ACO Benefits Summary Chart
140. Funding for Group Insurance Coverage Employee Benefits Funding for Group Insurance Coverage More Info on 140. Funding for Group Insurance Coverage
220. Retired Employees Employee Benefits Retired Employee Eligibility and Enrollment More Info on 220. Retired Employees
707. Retroactive Eligibility Adjustments Employee Benefits Retroactive Eligibility Adjustments More Info on 707. Retroactive Eligibility Adjustments
October 2020
Title Published Office File(s) Page
Grandchild Certification Form Employee Benefits Dependent Grandchild Certification Form More Info on Grandchild Certification Form
Section 55.03 FY 2020 Annual Report Historically Underutilized Business FY 2020-55.03 Report More Info on Section 55.03 FY 2020 Annual Report
December 2020
Title Published Office File(s) Page
UT CARES Act Employee Benefits UT CARES Act More Info on UT CARES Act
UT Benefits Billing Sample Monthly Statement Employee Benefits UT Benefits Billing Sample Monthly Statement More Info on UT Benefits Billing Sample Monthly Statement
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 CARE Part D Contacts Employee Benefits UT CARE Part D Contacts More Info on UT CARE Part D Contacts
July 2021
Title Published Office File(s) Page
UT CONNECT Highlights Brochure Employee Benefits UT CONNECT Highlights Brochure 2021-2022
UT CONNECT Highlights Brochure 2020-2021 		More Info on UT CONNECT Highlights Brochure
Vision Plans Annual Enrollment Overview Employee Benefits Vision Plans Annual Enrollment Overview 2021-2022 More Info on Vision Plans Annual Enrollment Overview
Superior Vision Online Retailers Employee Benefits Superior Vision Online Contacts and Lenses Retailers More Info on Superior Vision Online Retailers
Hinge Health Tip Sheets Employee Benefits Hinge Health Desk Exercises Tip Sheet
Hinge Health Find Your Fifteen Tip Sheet
Hinge Health Muscle Mindfulness Tip Sheet
Hinge Health Stand All Day Tip Sheet
Hinge Health Work From Home Tip Sheet 		More Info on Hinge Health Tip Sheets
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 		More Info on UT SELECT Livongo Overview & 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 		More Info on UT SELECT Omada Health Overview
MDLIVE Overview and Registration Info Employee Benefits MDLIVE Overview and Registration Flyer More Info on MDLIVE Overview and Registration Info
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 		More Info on UT SELECT Hinge Health Overview
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 		More Info on UT SELECT Ovia Health Overview
UT System Administration Standards of Conduct Systemwide Compliance UT System Administration Standards of Conduct More Info on UT System Administration Standards of Conduct
August 2021
Title Published Office File(s) Page
Overview of TRS and ORP Employee Benefits TRS and ORP Overview - July 2021 More Info on Overview of TRS and ORP
Notice of Creditable Coverage (NOCC) Employee Benefits Medicare Part D Notice of Creditable Coverage More Info on Notice of Creditable Coverage (NOCC)
September 2021
Title Published Office File(s) Page
Long-Term Disability Certificate Employee Benefits NEW! 2021-2022 Long Term Disability Certificate
2020-2021 Long Term Disability Certificate 		More Info on Long-Term Disability Certificate
Short-Term Disability Certificate Employee Benefits NEW! Short Term Disability Certificate 2021-2022
Short Term Disability Certificate 2020-2021 		More Info on Short-Term Disability Certificate