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Benefit Plan Documents
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Benefits Plan Documents
Additional plan flyers, resources, and presentations can be found on the Virtual Benefits Fair: https://mybenefits.nfp.com/UChicago/benefits-fair/
Adoption
Documents
Benefits Office
Documents
Cobra
Documents
Dental
Documents
Educational Assistance
Faculty
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Active Faculty Children's Scholarship Benefit Application - University of Chicago
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Active Faculty Children's Scholarship Benefit Application - Not University of Chicago
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Diverse Learners Tuition Portability Benefit Application 2025-2026
Staff
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Staff Children's Scholarship at UChicago Benefit Application
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Staff Tuition Assistance Outside of UChicago Benefit Application
Lab
Flexible Spending Accounts
Health Savings Account
Documents
Life and Disability Insurance Plans
VOYA Life Insurance Information
VOYA - Travel Assistance
View pdfVOYA Long-Term Disability Information
VOYA Short-Term Disability Information
VOYA Certificates of Coverage
Medical
BCBS General Forms
- BCBS Claim Form (Domestic)
- BCBS Claim Form (International)
- BCBS Disabled Dependent Authorization Form
- BCBS HIPAA Use or Disclosure Authorization Form
- BCBS - 24/7 Nurseline (HDHP and PPO)
- Teladoc Health Diabetes Management (HDHP and PPO)
- Teladoc Health Hypertension Management (HDHP and PPO)
- Teladoc Health Virtual Primary Care (HDHP and PPO)
BCBS HDHP Maroon Savings Plan
BCBS Blue Advantage HMO Plan
BCBS PPO Maroon Plan
University of Chicago Health Plan (UCHP)
UCHP - CVS Minute Clinic
View websitePrescription
CVS (BCBS PPO & HDHP, UCHP)
Prime Therapeutics (BCBS HMO)
Permanent Life Insurance/ Long-Term Care
Retiree Medical Plan
- Retiree Medical Plan - Guidebook 2025
- How to Apply Online for Medicare
- Medicare 101 - An Educational Event (Presentation)
- Medicare Part D Notice
- Retiree Medical Plan - VSRI Postponement Form
- Retiree Medical Plan - Enrollment Form
- Retiree Medical Plan - Postponement Form
- Retiree Medical Plan - Cancellation Form
Not Medicare Eligible (BCBS and UCHP)
Prescription Not Medicare Eligible (CVS)
Medicare Eligible (Aetna)
Aetna Medicare Advantage
- Additional Wellness Benefits
- Continuity of Care Form
- Enhanced Preventive Dental Value ESA
- Evidence of Coverage
- Explanation of Benefits Guide
- Healthy at Home
- How to Search for a Medicare Advantage Provider
- Information for Nonparticipating Providers
- Kidney Support
- Medicare Advantage Handbook
- Medicare Advantage Plan Summary
- SilverSneakers GO App
- SilverSneakers On-Demand
Aetna Medicare Supplement
Prescription Medicare Eligible (SilverScript)
Retirement
Documents
- Enrollment Guide - Contributory Retirement Plan
- Enrollment Guide - Retirement Income Plan for Employees (ERIP)
- Enrollment Guide - Supplemental Retirement Plan
- Enrollment Guide - 457(b) Deferred Compensation Plan
- Summary Plan Description - Contributory Retirement Plan
- Summary Plan Description - Retirement Income Plan for Employees (ERIP) Defined Contribution
- Summary Plan Description - Supplemental Retirement Plan
- Summary Plan Description - ERIP (Non-Local 743) Defined Benefit
- Summary Plan Description - SEPP (Non-Local 743) Defined Benefit
- Local 743 Members Currently Accruing Benefits Under SEPP Defined Benefit Program
- Local 743 Members Defined Benefit Plan for Those who Elected to be Covered Under Enhanced ERIP after October 31, 2016