2020 - 2021 Benefits Overview

21-08-01 Summary of Benefits
File Size: 180 kb
File Type: pdf
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21-08-01 Medical Plan Comparison
File Size: 116 kb
File Type: pdf
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21-08-01 Healthcare Premiums Payroll Deductions
File Size: 60 kb
File Type: pdf
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21-08-01 Open Enrollment Memo
File Size: 296 kb
File Type: pdf
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21-08-01 Benefits Digest
File Size: 6385 kb
File Type: pdf
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21-08-01 Annual Notice Packet
File Size: 576 kb
File Type: pdf
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Benefits Enrollment Form

Medical and Dental

Summaries of Benefits and Coverage (SBCs)
21-08-01 SBC -- Medical - Buy Up Plan
File Size: 856 kb
File Type: pdf
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21-08-01 SBC -- Medical - HDHP with HSA Plan
File Size: 853 kb
File Type: pdf
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21-08-01 SBC -- Medical - Base Plan
File Size: 853 kb
File Type: pdf
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21-06-24 Summary of Benefits and Coverage -- Vision
File Size: 67 kb
File Type: pdf
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18-08-01 SBC -- Dental
File Size: 176 kb
File Type: pdf
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Certificates of Coverage (COCs)
20-08-01 COC -- Medical -- Buy Up Plan
File Size: 1473 kb
File Type: pdf
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20-08-01 COC -- Medical - Base Plan
File Size: 1303 kb
File Type: pdf
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20-08-01 COC -- Medical - HDHP with HSA Plan
File Size: 1468 kb
File Type: pdf
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20-08-01 COC -- Vision
File Size: 619 kb
File Type: pdf
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20-08-01 COC -- Dental
File Size: 614 kb
File Type: pdf
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Health Savings Account (Available only with the HDHP/HSA Health Plan)
17-08-01 HSA Summary
File Size: 1143 kb
File Type: pdf
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17-08-01 HSA Employee Contribution Form
File Size: 172 kb
File Type: pdf
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Prescription Drug Information
20-08-01 UnitedHealthcare Prescription Drug FAQs
File Size: 56 kb
File Type: pdf
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2019 Optum Rx Welcome Brochure
File Size: 1651 kb
File Type: pdf
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21-09-01 3-Tier Prescription Drug List (Base and Buy-Up Plans)
File Size: 1417 kb
File Type: pdf
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21-09-01 4-Tier Prescription Drug List (HDHP/HSA Plan)
File Size: 844 kb
File Type: pdf
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2019 Prescription Mail Order Flier
File Size: 719 kb
File Type: pdf
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2019 Prescription Mail Order Form
File Size: 120 kb
File Type: pdf
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Life and Disability

19-08-01 UHC Life Member Welcome Brochure
File Size: 577 kb
File Type: pdf
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2019 Long Term Disability Welcome Brochure
File Size: 507 kb
File Type: pdf
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21-01-01 Short Term Disability Welcome Brochure
File Size: 5293 kb
File Type: pdf
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Certificates of Coverage
21-01-01 COC -- Group Life and AD&D
File Size: 258 kb
File Type: pdf
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21-01-01 COC -- Long Term Disability (F-T/Salaried Employees)
File Size: 225 kb
File Type: pdf
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21-01-01 COC -- Short Term Disability (Class 1)
File Size: 208 kb
File Type: pdf
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21-06-25 Summary of Benefits -- Long Term Disability
File Size: 202 kb
File Type: pdf
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Claim Forms
UHC Life Claim Form (For IN, AR, CO, KS, MD, NC, ND, NV, NY
File Size: 65 kb
File Type: pdf
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UHC Life Claim Form for All Other States
File Size: 132 kb
File Type: pdf
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2019 Long Term Disability Claim Form
File Size: 829 kb
File Type: pdf
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Other UHC Life Forms
19-08-01 UHC Supplemental Life Enrollment Form
File Size: 121 kb
File Type: pdf
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19-08-01 UHC Life Beneficiary Designation Change
File Size: 82 kb
File Type: pdf
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Flexible Spending Accounts (FSAs)

19-08-01 FSA Enrollment Guide
File Size: 2681 kb
File Type: pdf
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Summary Plan Description -- FSA
File Size: 554 kb
File Type: pdf
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19-08-01 FSA Enrollment Form
File Size: 339 kb
File Type: pdf
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FSA Claim Form
File Size: 65 kb
File Type: pdf
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401(k)

20-09-01_401_k__enrollment_booklet.pdf
File Size: 2273 kb
File Type: pdf
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2019_401_k__eligibility_requirements.pdf
File Size: 94 kb
File Type: pdf
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20-12-01_participant_fee_disclosure_notice_for_2021.pdf
File Size: 79 kb
File Type: pdf
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20-12-01_qdia_notice_for_2021.pdf
File Size: 68 kb
File Type: pdf
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20-12-01_safe_harbor_notice_for_2021.pdf
File Size: 69 kb
File Type: pdf
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highmark_401k_distribution_form.pdf
File Size: 102 kb
File Type: pdf
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highmark_401k_rollover_form.pdf
File Size: 55 kb
File Type: pdf
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highmark_401k_loan_request_form.pdf
File Size: 56 kb
File Type: pdf
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highmark_401k_hardship_form.pdf
File Size: 100 kb
File Type: pdf
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