Document Library

CCHP/Balance

• HMO Plan Overview
• HMO Primary Care Providers

UMR

• Member Claim Form
• Health Benefit Summary Plan Description (SPD)
• Retiree Post-65 Medicare Supplemental Plan Summary

Teladoc

• How to Register for Teladoc

Omada Diabetes Program

• Program Overview
• Frequently Asked Questions (FAQs)

Other

• Hertz Custom Benefit Plan (HCBP) Document

• Pharmacy Benefits Summary
• Preventive Medications List
• Specialty Drug List
• Rx Savings Solutions Program Overview

OptumRx

• Home Delivery Form
• Member Reimbursement Drug Claim Form

Total Cigna Dental PPO Plan

• How to Find a Dentist
• Pre-Enrollment Overview
• Plan Guide
• Plan B Benefit Summary
• Plan B SPD
• Plan C Benefit Summary
• Plan C SPD

Cigna Dental Care HMO Plan

• Plan Guide
• Dental Claim Form
• Fees Overview
• Patient Charge Schedule
• HMO SPD

Oral Health Integration Program

• Program Overview

• EyeMed Summary of Benefits
• Resumen de beneficios de EyeMed
• Out-of-Network Claim Form

• Employee Assistance Program
• Tobacco Cessation Program
• Early Steps Maternity
• Lactation Accommodation

• User Guide
• Online Tools
• Consolidate Your HSA Balances
• Rollover or Transfer Request Form
• Explore Your HSA with Optum Bank Academy
• Frequently Asked Questions (FAQs)
• Why Choose the CDHP with an HSA?
• HSA: Part of Your Financial Plan

Using Your FSA

• User Guide
• Activate Your FSA Debit Card

FSA Forms

• Direct Deposit Authorization Form
• Automatic Reimbursement Enrollment Form
• Automatic Reimbursement Waiver/Election Change/Opt-Out Form
• Health Care Reimbursement Request Form
• Dependent Care Reimbursement Account Request Form

Life Insurance

• Supplemental Life Insurance Benefit Highlights
• Life Insurance SPD for Active Employees
• Life Insurance SPD for Employees Hired before January 1990
• Life Insurance SPD for Retirees (Retired before January 1990)

Accidental Death & Dismemberment (AD&D) Insurance

• Accidental Death Claim Form
• Voluntary AD&D Insurance Benefit Highlights
• Funeral Concierge Services
• Travel Assistance & ID Theft Protection Services
• Other Services

Short-Term Disability (STD)

• STD 50 Option Benefit Summary
• STD 60 Option Benefit Summary
• Non-Contributory STD Benefit Summary

Long-Term Disability (LTD)

• LTD Pre-Tax Benefit Summary
• LTD Post-Tax Benefit Summary

Additional Resources

• File a Claim or Request Leave
• Salary Continuation Policy for Exempt Employees

• Personalized Planning & Advice
• Income Savings Plan Summary Plan Description (SPD)
• Income Savings Plan Notice of Safe Harbor Features