Forms and Publications

Medical
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24/7 Nurseline Employee Benefits 24/7 Nurseline
Airrosti Brochure Employee Benefits Fix Pain Fast
Complimentary Virtual Injury & Pain (VIP) Chat with a Provider
Annual Enrollment Medical Plans Highlights Employee Benefits 2022 Annual Enrollment Medical Plans Highlights for Employees & Retirees
BCBSTX Annual Wellness Checklist Employee Benefits BCBSTX Annual Wellness Checklist for UT Benefits Members
BCBSTX Behavioral Health: Substance Abuse Employee Benefits BCBSTX Behavioral Health: Substance Abuse Flyer
Glossary of Health Coverage and Medical Terms Employee Benefits Uniform Glossary of Health Coverage and Medical Terms
How to Log in to My UT Benefits for Retirees Employee Benefits How to Log in to My UT Benefits for Retirees
J-Visa Summary of Benefits and Coverage Employee Benefits NEW! 2024-2025 Summary of Benefits: J-Visa Plan
2023-2024 Summary of Benefits: J-Visa Plan
2023-2024 Summary of Benefits: J-Visa Plan (Spanish/Español)
Know Your Behavioral Health Network Employee Benefits UT SELECT Know Your Behavioral Health Network
Learn to Live Resources for Your Mental Wellbeing Employee Benefits UT SELECT Learn to Live Resources for Your Mental Wellbeing 2024
Out-of-Area Network Summary of Benefits and Coverage Employee Benefits NEW! 2024-2025 Summary of Benefits: Out-of-Area Plan
2023-2024 Summary of Benefits: Out-of-Area Plan
2023-2024 Summary of Benefits: Out-of-Area Plan (Spanish/Español)
Perinatal Wellness Guidelines Employee Benefits Recommendations for a Healthy Pregnancy
Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Employee Benefits Tobacco Cessation Program Physician Statement
PPO Network Summary of Benefits and Coverage Employee Benefits NEW! 2024-2025 Summary of Benefits: PPO Plan
2023-2024 Summary of Benefits: PPO Plan
2023-2024 Summary of Benefits: PPO Plan (Spanish/Español)
Preventive Services for Adults Employee Benefits Adult Wellness Guidelines
Preventive Services for All Ages Employee Benefits Family Wellness and Preventive Care
Preventive Services for Children Employee Benefits Wellness Guidelines for Children
Progyny Fertility Benefits Brochure & Member Guide Employee Benefits Progyny Fertility Benefits Overview
Seasons of Life Employee Benefits UT SELECT Seasons of Life Brochure
UT SELECT Seasons of Life Presentation
Tobacco Premium Program Declaration Form Employee Benefits Tobacco Premium Program Declaration Form
UT CARE Eligibility Flow Chart Employee Benefits UT CARE Eligibility Flow Chart
UT CARE Eligibility Groups Employee Benefits UT CARE Eligibility Groups
UT CARE Medicare Enrollment Brochure Employee Benefits UT CARE Medicare Enrollment Brochure
UT CARE Medicare Importance of Part A and B Employee Benefits UT CARE: The importance of enrolling in Medicare Part A and Part B
UT CARE Medicare Overview Employee Benefits UT CARE Medicare Overview 2024
UT CARE Medicare Overview 2025
UT CARE Medicare Plan in Other Languages Employee Benefits UT CARE Medicare Plan in Other Languages
UT CARE Medicare Plan Providers and Network Employee Benefits UT CARE Medicare Plan Providers and Network
UT CARE Medicare Plan: Ease into Medicare Employee Benefits UT CARE Medicare Plan: Ease into Medicare
UT CARE Medicare Sample Enrollment Kit Employee Benefits UT CARE Medicare Sample Enrollment Kit
UT CARE Medicare Kit de Inscripción (en Español)
UT CARE Medicare Welcome Letter Employee Benefits UT CARE Medicare Welcome Letter
UT CARE Quick Start Reference Sheet Employee Benefits UT CARE Quick Start Reference Sheet
UT Health Network Flyer Employee Benefits UT Health Network Flyer 2022
UT SELECT Benefits at a Glance Brochure Employee Benefits NEW! 2024-2025 UT SELECT Benefits At-a-Glance Brochure
2023-2024 UT SELECT Benefits At-a-Glance Brochure
UT SELECT Benefits Summary Chart Employee Benefits UT SELECT Benefits Summary Chart 2024-2025
UT SELECT Blue Access for Members Employee Benefits UT SELECT Blue Access for Members 2024
UT SELECT Cancer Services and Support Employee Benefits UT SELECT Cancer Services and Support Program
UT SELECT Health Advocacy Solutions Employee Benefits UT SELECT Health Advocacy Solutions 2024
BCBSTX Health Advocacy Solutions: Social Determinants of Health 2023
UT SELECT Health Advocate at BCBSTX Employee Benefits UT SELECT Health Advocate at BCBSTX
UT SELECT Health Advocate Solutions FAQs Employee Benefits UT SELECT Health Advocate Solutions FAQs
UT SELECT Health Advocate Solutions Infographic Employee Benefits UT SELECT Health Advocate Solutions Infographic
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 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 MDLIVE Overview Employee Benefits UT SELECT MDLIVE Brochure 2024
UT SELECT MDLIVE: How to Register Employee Benefits UT SELECT MDLIVE: Register today so you’re ready when you need care
UT SELECT Medical Claim Form Employee Benefits UT SELECT Medical Claim Form
UT SELECT Medical Plan Guide with Prescription Drug Coverage Employee Benefits NEW! 2024-2025 UT SELECT Benefits Guide
2023-2024 UT SELECT Benefits Guide
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 Ovia Health Overview Employee Benefits UT SELECT Ovia Health General Overview
UT SELECT Ovia Health Support for LGBTQ Families
UT SELECT Tobacco Cessation Program Employee Benefits UT SELECT Tobacco Cessation Program
Pharmacy
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Accredo Specialty Pharmacy Employee Benefits Accredo Specialty Pharmacy Flyer
Express Scripts 90-Day Supply Employee Benefits Express Scripts: Relax with 90-day Supplies
Express Scripts Print and Digital ID Cards Employee Benefits Express Scripts Print and Digital ID Cards
Express Scripts: How to Register Online Employee Benefits Express Scripts: How to Register Online
Express Scripts: Manage Your Prescription Plan Employee Benefits Express Scripts: Manage Your Prescription Plan
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
NEW! UT CARE Medicare Prescription Drug Program at-a-Glance 2024
Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form Employee Benefits Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form
Prescriptions by Mail Order Form Employee Benefits Prescriptions by Mail Order Form
UT CARE Part D Benefit Overview Employee Benefits 2024 UT CARE Part D Benefit Overview
UT CARE Part D Contacts Employee Benefits UT CARE Part D Contacts
UT CARE Part D Formulary Employee Benefits 2024 UT CARE Part D Formulary
UT CARE Part D Welcome Kit Employee Benefits 2023 UT CARE Part D Welcome Kit
UT CARE Part D Welcome Kit Letter Employee Benefits 2024 UT CARE Part D Welcome Kit Letter
UT SELECT Part D Evidence of Coverage Employee Benefits UT SELECT Part D Evidence of Coverage
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
Special Notices
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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
BAC By-Laws Employee Benefits BAC By-laws
HIPAA Breach Log Employee Benefits HIPAA Breach Log
HIPAA Complaint Form Employee Benefits HIPAA Complaint Form
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 Request for Accounting of Disclosures Employee Benefits HIPAA Request for Accounting of Disclosues Form
HIPAA Request for Amendment of Protected Health Information Employee Benefits HIPAA Request for Amendment of Protected Health Information Form
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 Revocation of Authorization Employee Benefits HIPAA Revocation of Authorization Form
HIPAA Staff Assistance Authorization Employee Benefits HIPAA Staff Assistance Authorization
Legal Notices Employee Benefits UT Benefits - Legal Notices 2024 (effective September 1, 2024)
UT Benefits - Legal Notices 2023 (effective September 1, 2023)
Medicaid and the Children's Health Insurance Program (CHIP) Notice Employee Benefits Medicaid and the Children's Health Insurance Program (CHIP) Notice
Nondiscrimination and Accessibility Notice Employee Benefits Nondiscrimination and Accessibility Notice
Notice of Creditable Coverage (NOCC) Employee Benefits Medicare Part D Notice of Creditable Coverage
UT Retirement Program
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Annual Eligibility Notice for Retirement Plans Employee Benefits Annual Eligibility Notice for Retirement Plans
Annual Leave Deferral Agreement Employee Benefits Annual Leave Deferral Agreement
Comparison of Traditional, Roth 403(b), and Roth IRA Contributions Employee Benefits Comparison of Traditional, Roth 403(b), and Roth IRA Contributions
DCP Catch-Up Provision Agreement Employee Benefits DCP Catch-Up Provision Agreement
ORP Acknowledgement Employee Benefits ORP Acknowledgement
ORP Authorization for Reduction for Employee Contribution Employee Benefits ORP Authorization for Reduction for Employee Contribution
ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE Employee Benefits ORP Authorization for Reduction for Employee Contribution RETURNING EMPLOYEE
Overview of TRS and ORP Employee Benefits TRS and ORP Overview - July 2021
Purchase Change Agreement (All plans) Employee Benefits UT Retirement Purchase Change Agreement (All plans)
Retirement Program Sales Solicitation Agreement Employee Benefits Retirement Program Sales Solicitation Agreement
Summary of Retirement Programs Employee Benefits Retirement Programs Summary
TRS Form 28 (Notice to Elect to Participate in Optional Retirement Program and/or Refund) Employee Benefits TRS Form 28 (Oct 2019)
UT Transfer Verification Form (All plans) Employee Benefits UT Transfer Verification Form (All plans)
UTSaver Loan and Inservice Distribution Options Employee Benefits UTSaver Loan and Inservice Distribution Options
UTSaver TSA Disclosure Form Employee Benefits UTSaver TSA Disclosure Form
Vendor Services Employee Benefits Vendor Services for Retirement Participants
Vesting/Termination Status Form Employee Benefits Vesting/Termination Status Form
Voluntary Retirement Programs At a Glance Employee Benefits Voluntary Retirement Programs
Weathering the Storm Employee Benefits Weathering the Storm
Benefits Handbooks and Cost Worksheet
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Annual Enrollment & Resource Guide for Employees Employee Benefits NEW! 2024-2025 Annual Enrollment & Resource Guide for Employees
2023-2024 Annual Enrollment & Resource Guide for Employees
Annual Enrollment & Resource Guide for Retired Employees Employee Benefits NEW! 2024-2025 Annual Enrollment & Resource Guide for Retired Employees
2023-2024 Annual Enrollment & Resource Guide for Retired Employees
Annual Enrollment Highlights for Employees Employee Benefits NEW! 2024-2025 Annual Enrollment Highlights for Employees
2023-2024 Annual Enrollment Highlights for Employees
Annual Enrollment Highlights for Retired Employees Employee Benefits NEW! 2024-2025 Annual Enrollment Highlights for Retired Employees
2023-2024 Annual Enrollment Highlights for Retired Employees
Benefits Cost Worksheet for Employees Employee Benefits 2024-2025 Active Employee Cost Worksheet
2023-2024 Active Employee Cost Worksheet
Benefits Cost Worksheet for Retired Employees Employee Benefits 2024-2025 Retired Employee Cost Worksheet
2023-2024 Retired Employee Cost Worksheet
UT Benefits Enrollment Guide for Employees Employee Benefits NEW! 2024-2025 UT Benefits Enrollment Guide for Employees
2023-2024 UT Benefits Enrollment Guide for Employees
UT Benefits Enrollment Guide for Retiring Employees Employee Benefits NEW! 2024-2025 UT Benefits Enrollment Guide for Retiring Employees
2023-2024 UT Benefits Enrollment Guide for Retiring Employees
Other
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Benefits Coverage Mapping for SFA Employees & Retirees Employee Benefits Benefits Coverage Mapping for SFA Employees
Benefits Coverage Mapping for SFA Retirees
Blue Cross and Blue Shield of Texas Fitness Program Employee Benefits BCBSTX Fitness Program for UT SELECT 2024
COBRA Application FAQs Employee Benefits COBRA Application FAQs 2023-2024
COBRA General Notice Employee Benefits COBRA General Notice for the 2024-2025 Plan Year
COBRA Rates Employee Benefits COBRA Rates 2024-2025
COBRA Rates 2023-2024
Enrolling as a New Hire During Annual Enrollment Employee Benefits Enrolling as a New Hire During Annual Enrollment
Grandchild Certification Form Employee Benefits Dependent Grandchild Certification Form
Insurance FAQs for Stephen F. Austin State University Employee Benefits Insurance FAQs for SFA University Members
Living Well Platform How to Guide Employee Benefits Living Well Platform How to Guide
Living Well Resources Guide Employee Benefits NEW! Living Well Resources Guide 2024-2025
Living Well Resources Guide 2023-2024
Office of Employee Benefits Organizational Chart Employee Benefits Office of Employee Benefits Organizational Chart
SFA Benefits Comparison Employee Benefits SFA Benefits Comparison for Employees and Retirees
SilverSneakers Fitness Program Employee Benefits SilverSneakers Fitness Program for Retirees
SilverSneakers Tuition Rewards Flyer Employee Benefits SilverSneakers Tuition Rewards Flyer
SilverSneakers Tuition Rewards Flyer (Español)
UT Living Well FAQs for Stephen F. Austin State University Employee Benefits UT Living Well FAQs for SFA University Members
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
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)
Retirement Plan Publications
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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?
Fidelity Investments Information Employee Benefits Fidelity Investments Fact Sheet
Enroll in UT Retirement with Fidelity Investments
Getting Started with your Fidelity Account
Fidelity Investments Mobile App 2024
Ways to Work with Fidelity Investments: Call, Click, or Visit
Create Your Budget: Understanding Your Spending Activity Sheet
Lincoln Financial Information Employee Benefits 2024 Lincoln Financial Group Brochure
2024 Lincoln Financial Group Plan Representative & Support
Lincoln Financial: Register for online account access
Understanding the UT Optional Retirement Program (ORP)
Lincoln Financial: Review your Beneficiaries Today
Pretax or Roth: Understanding Roth Contributions
Logging Into Retirement Manager Employee Benefits Logging Into Retirement Manager
TIAA Information Employee Benefits NEW! TIAA Benefit of Starting Now
NEW! TIAA Benefits of One Percent
NEW! Retirement Planning for New Hires
NEW! TIAA: Enroll Today
NEW! Stay Connected with TIAA
UT CARES Act Employee Benefits UT CARES Act
UT Retirement Vendor Engagement Portfolio Employee Benefits UT Retirement Vendor Engagement Portfolio
UTSaver Retirement Plans Employee Benefits 2024-2025 UTSaver Retirement Plans
2023-2024 UTSaver Retirement Plans
Voya Financial Information Employee Benefits NEW! Voya Financial: Brochure 2024
Voya Financial: UTSaver 457(b) Deferred Compensation Plan
Voya Financial: The Cost of Waiting
Voya Financial: Managing Key Risks to Make Your Retirement Income Last
Voya Financial: 2024 Webinars
Voya Financial: Increasing your Contributions
Dental
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Delta Dental Go PPO Employee Benefits Delta Dental Go PPO: 6 great reasons to stay in-network
Delta Dental Grin E-Magazine Employee Benefits Delta Dental Grin! E-Magazine
Delta Dental Manage Your Plan Online Employee Benefits Delta Dental: Go online to manage your plan
Delta Dental Mouth and Body Connection Employee Benefits Delta Dental: The vital connection between oral health and overall health
Delta Dental Savings with BrushSmart Employee Benefits Delta Dental BrushSmart Savings
Delta Dental Support for Chronic Conditions Employee Benefits Delta Dental Support for Chronic Conditions with SmileWay
Delta Dental Support with LifePerks Employee Benefits Delta Dental Features with LifePerks
DeltaCare Benefits Guide Employee Benefits 2023-2024 DeltaCare Benefits Guide
DeltaCare Description of Benefits & Highlights Employee Benefits DeltaCare Description of Benefits & Highlights
DeltaCare Highlights Employee Benefits DeltaCare Highlights
UT SELECT DENTAL Benefits Guide Employee Benefits NEW! 2024-2025 UT SELECT DENTAL Benefits Guide
2023-2024 UT SELECT DENTAL Benefits Guide
UT SELECT DENTAL Claim Form Employee Benefits UT SELECT DENTAL Claim Form
UT SELECT DENTAL Highlights Employee Benefits UT SELECT DENTAL Highlights
UT SELECT DENTAL Plus Benefits Guide Employee Benefits NEW! 2024-2025 UT SELECT DENTAL Plus Benefits Guide
2023-2024 UT SELECT DENTAL Plus Benefits Guide
UT SELECT DENTAL Plus Highlights Employee Benefits UT SELECT DENTAL Plus Highlights
Your Dental Plan Options Employee Benefits Dental Plan Options: Compare Our Plans
Vision
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Finding-In-Network Providers Employee Benefits Find an In-Network Eye Care Professional
Quality LASIK for Texas Members Employee Benefits Quality LASIK for Texas Members
Smart Alert - Partnering for Total Wellness Employee Benefits Superior Vision Smart Alert
Superior Vision Care Cost Estimator Employee Benefits NEW! Superior Vision Care Cost Estimator Tool
Superior Vision Member Discounts Employee Benefits Superior Vision Member Hearing Network Discount
Superior Vision Member Discounts
Superior Vision Mobile App Employee Benefits Superior Vision Mobile App
Superior Vision Online Retailers Employee Benefits NEW! Introducing Warby Parker through MetLife® Vision
Superior Vision Online Contacts and Lenses Retailers
Superior Vision Plan Brochure Employee Benefits Superior Vision Plan Brochure
Superior Vision Plan Highlights Employee Benefits NEW! Superior Vision Highlights 2024-2025
Superior Vision Plus Benefits Guide Employee Benefits Superior Vision Plus Plan Certificate
Superior Vision Standard Benefits Guide Employee Benefits Superior Vision Standard Plan Certificate
Superior Vision: Getting Started with the Online Member Portal Employee Benefits Superior Vision Online Member Portal
Superior Vision: Laser Vision Correction (LASIK) Employee Benefits Superior Vision: Laser Vision Correction (LASIK)
Superior Vison Claim Form Employee Benefits Superior Vison Claim Form
The Importance of an Eye Exam Employee Benefits Superior Vision: The Importance of an Eye Exam
Tips Caring for your Eyes Wearing Contacts Employee Benefits Tips for Caring for your Eyes While Wearing Contacts