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Medical
Document Office Publish Date File
UT SELECT Weight Management Program Employee Benefits Weight Management Program
UT SELECT Medical Claim Form Employee Benefits UT SELECT Medical Claim Form
UT SELECT Tobacco Cessation Program Employee Benefits UT SELECT Tobacco Cessation Program
24/7 Nurseline Employee Benefits 24/7 Nurseline
Glossary of Health Coverage and Medical Terms Employee Benefits Glossary of Health Coverage and Medical Terms
UT Health Network Flyer Employee Benefits UT Health Network Flyer 2018-2019
UT SELECT Benefits Summary Chart Employee Benefits UT SELECT Benefits Summary Chart 2019-2020
UT SELECT Benefits Summary Chart 2018-2019
UT CONNECT ACO Benefits Summary Chart Employee Benefits UT CONNECT ACO Benefits Summary Chart 2019-2020
UT CONNECT ACO Benefits Summary Chart 2018-2019
Tobacco Premium Program Declaration Form Employee Benefits Tobacco Premium Program Declaration Form
UT SELECT Medical Plan Guide with Prescription Drug Coverage Employee Benefits
Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Employee Benefits Tobacco Cessation Program Physician Statement
UT SELECT Benefits at a Glance Brochure Employee Benefits 2020-2021 UT SELECT Benefits At-a-Glance Brochure
UT CONNECT ACO Network Summary of Benefits and Coverage Employee Benefits 2020-2021 Summary of Benefits: UT CONNECT ACO Plan
2020-2021 Summary of Benefits: UT CONNECT ACO Plan (Spanish/Español)
PPO Network Summary of Benefits and Coverage Employee Benefits 2020-2021 Summary of Benefits: PPO Plan
2019-2020 Summary of Benefits: PPO Plan
2019-2020 Summary of Benefits: PPO Plan (Spanish/Español)
Out-of-Area Network Summary of Benefits and Coverage Employee Benefits 2020-2021 Summary of Benefits: Out-of-Area Plan
2019-2020 Summary of Benefits: Out-of-Area Plan
2019-2020 Summary of Benefits and Coverage: Out-of-Area Plan (Spanish/Español)
UT SELECT Livongo Overview Employee Benefits Livongo Brochure 2020
Livongo Hypertension Brochure 2020
Livongo FAQs
UT CONNECT Ovia Health Overview Employee Benefits UT CONNECT Ovia Health Overview 2020-2021
UT CONNECT Ovia Health Maternity App 2020-2021
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 Highlights Brochure Employee Benefits UT CONNECT Highlights Brochure 2020-2021
UT SELECT MDLIVE Overview Employee Benefits MDLIVE Brochure 2020
Airrosti Brochure Employee Benefits Airrosti: Recover Faster with Airrosti 2020
UT SELECT Omada Health Overview Employee Benefits Omada Health Brochure 2020
Omada Health FAQs 2020
UT CONNECT MDLIVE Information Employee Benefits UT CONNECT MDLIVE Information 2020-2021
UT SELECT Hinge Health Overview Employee Benefits Hinge Health Brochure 2020
Hinge Health Enrollment 2020
UT SELECT Ovia Health Overview Employee Benefits UT SELECT Ovia Health Overview 2020-2021
UT SELECT Ovia Health Maternity App 2020-2021
UT CONNECT ACO Medical Plan FAQs Employee Benefits UT CONNECT FAQs 2020-2021
UT CONNECT FAQs 2019-2020
UT CONNECT Benefit Chart Comparison Employee Benefits UT CONNECT Benefit Chart Comparison 2020-2021
UT SELECT Health Advocacy Solutions Employee Benefits UT SELECT Health Advocacy Solutions Brochure 2020
UT SELECT Health Advocacy Solutions Infographic 2020
Vision
Document Office Publish Date File
Getting Started with the Online Member Portal Employee Benefits Superior Vision Online Member Portal
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 Plan Highlights Employee Benefits Superior Vision Highlights
The Importance of an Eye Exam Employee Benefits Superior Vision: The Importance of an Eye Exam
Superior Vision Online Retailers Employee Benefits Superior Vision Online Contacts and Lenses Retailers
Tips Caring for your Eyes Wearing Contacts Employee Benefits Tips for Caring for your Eyes While Wearing Contacts
Finding-In-Network Providers Employee Benefits Find an In-Network Eye Care Professional 2020
Superior Vision Mobile App Employee Benefits Superior Vision Mobile App 2020
Superior Vision Member Discounts Employee Benefits Superior Vision Member Discounts
Superior Vision Member Hearing Network Discount
Short-Term Disability (STD)
Document Office Publish Date File
Short-Term Disability Certificate Employee Benefits Short Term Disability Certificate
Short Term Disability Brochure Employee Benefits Short Term Disability Brochure
Long-Term Disability (LTD)
Document Office Publish Date File
Long-Term Disability Certificate Employee Benefits Long Term Disability Certificate
Long-Term Disability Benefit Highlights Employee Benefits Long Term Disability Brochure
Special Notices
Document Office Publish Date File
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 Confidential Communications of Medical Information Employee Benefits HIPAA Request for Confidential Communications of Medical Information Form
HIPAA Request for Amendment of Protected Health Information Employee Benefits HIPAA Request for Amendment of Protected Health Information Form
Notice of Creditable Coverage (NOCC) Employee Benefits Medicare Part D Notice of Creditable Coverage
HIPAA General Authorization Form Employee Benefits HIPAA General Authorization Form
HIPAA Request for Access to Protected Health Information Employee Benefits Request for Access Form
HIPAA Revocation of Authorization Employee Benefits HIPAA Revocation of Authorization 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 Complaint Form Employee Benefits HIPAA Complaint Form
BAC By-Laws Employee Benefits BAC By-laws
Nondiscrimination and Accessibility Notice Employee Benefits Nondiscrimination and Accessibility Notice
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
Medicaid and the Children's Health Insurance Program (CHIP) Notice Employee Benefits Medicaid and the Children's Health Insurance Program (CHIP) Notice
Legal Notices Employee Benefits UT Benefits - Legal Notices 2020
UT Benefits - Legal Notices 2019
UT Retirement Program
Document Office Publish Date File
UTSaver TSA Disclosure Form Employee Benefits UTSaver TSA Disclosure Form
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
Purchase Change Agreement (All plans) Employee Benefits UT Retirement Purchase Change Agreement (All plans)
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)
Vendor Services Employee Benefits Vendor Services for Retirement Participants
ORP Acknowledgement Employee Benefits ORP Acknowledgement
Vesting/Termination Status Form Employee Benefits Vesting/Termination Status Form
DCP Purchase Agreement Employee Benefits DCP Purchase Agreement
Overview of TRS and ORP Employee Benefits TRS and ORP Overview - July 2019
TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund) Employee Benefits TRS Form 28
Comparison of Traditional, Roth 403(b), and Roth IRA Contributions Employee Benefits Comparison of Traditional, Roth 403(b), and Roth IRA Contributions
Voluntary Retirement Programs At a Glance Employee Benefits Voluntary Retirement Programs
Summary of Retirement Programs Employee Benefits Retirement Programs Summary
Voluntary Retirement Programs Loan and Hardship Options Employee Benefits Voluntary Retirement Programs Loan and Hardship Options
Annual Eligibility Notice for Retirement Plans Employee Benefits Annual Eligibility Notice for Retirement Plans
Retirement Program Sales Solicitation Agreement Employee Benefits Retirement Program Sales Solicitation Agreement