Benefit Plan Documents

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• Flexible Spending Accounts

• Health Savings Account

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• Medical

• Permanent Life Insurance with Long-Term Care

• Retiree Medical Plan

• Retirement Program

• Summary of Material Modifications for CRP, ERIP, and SRP

• Vision

• Additional Benefits

Benefit Plan Documents

Additional plan flyers, resources, and presentations can be found on the Virtual Benefits Fair: https://mybenefits.nfp.com/UChicago/benefits-fair/

Adoption

• Adoption Policy 

• Adoption Assistance Application

Benefits Office

• Benefits Upon Separation

• IRS Section 125

COBRA

• COBRA Initial Rights Notice

Dental

• MetLife Dental Core Plan Certificate 2024

• MetLife Dental Buy-Up Plan Certificate 2024

• 2024 Dental Plan Comparison Chart

• Dental Wellness

• MetLife Mobile

Educational Assistance

• University of Chicago Educational Assistance Plan

• Locating your Employee Identification Number (EIN)

Faculty

• Active Faculty Children's Scholarship Benefit Application - University of Chicago 

• Active Faculty Children's Scholarship Benefit Application - Not University of Chicago 

• Diverse Learners Tuition Portability Benefit Application 2025-2026

• Diverse Learners Frequently Asked Questions (FAQs)

• Retired Faculty Children's Scholarship

Staff 

• Staff Children's Scholarship at UChicago Benefit Application

• Staff Tuition Assistance Outside of UChicago Benefit Application

• Staff Tuition at UChicago Benefit Application

• Graham School University Employee Registration

• UChicago Professional Education ( UCPE ) Registration 

LAB

• Lab Tuition Remission Frequently Asked Questions (FAQs)

• Lab Tuition Remission Quick Reference Guide (QRG)

• How to Check the Status and Approved Amount of Your Lab Remission Request 

• Lab Tuition Remission Video Tutorial

• Lab AGI Reference Table

Flexible Spending Accounts

• FSA Cafeteria Plan Document

• FSA Cafeteria Plan Document Amendment

• Health Equity Visa Debit Card

• Health Equity Pin Member Communication

• Summary Plan Document - FSA

Dependent Care FSA

• Dependent Care - Claim Form

• Dependent Care - Eligible Expenses

• Dependent Care - Regulations for Dependent Care Expenses

Health Care FSA

• Health Care FSA - How To File a Claim

• Health Care FSA - Eligible Expenses

Health Savings Account

• Health Savings Account - Account Holder Guide

• Health Savings Account - Continue Your HSA After Leaving the University

• Health Savings Account - Death Beneficiary Form

• Health Savings Account - Importance of Designating a Beneficiary

• Health Savings Account - Investment Options

• Health Savings Account - Rates and Tax Information

• Health Savings Account - Why Contribute? 

• Health Savings Account - Mobile App

• Health Savings Account - New Benefit Card 2025 Information 

Life and Disability Insurance Plans  

VOYA Life Insurance Information

• VOYA - Group Term Life Insurance (General) 

• VOYA -  Group Term Life Insurance Conversion Information Request 

• VOYA - Group Term Life Insurance Claim Checklist and FAQs

• VOYA - Group Term Life Portability Application (Spouse)

• VOYA - Personal Accident Insurance (AD&D)

• VOYA - Funeral Planning and Will Preparation

• VOYA - Travel Assistance

VOYA Long-Term Disability Information

• VOYA - LTD Income Insurance (Full Time and Part Time)

• VOYA - LTD Income Insurance (Local 73 and 743)

• VOYA - LTD Income Insurance (Physicians)

• VOYA - LTD Conversion Information Request

• VOYA - How to file a Disability Claim

• VOYA - LTD Call-in Instructions

VOYA Short-Term Disability Information

• VOYA - STD Request a Leave of Absence

• VOYA - STD Weekly Disability Income Plan

• VOYA - STD Mandated State Forms

• VOYA - STD Privacy Notice

VOYA Certificates of Coverage

• VOYA - LIFE - Group Term Life Certificate

• VOYA - LIFE - Police Officers Certificate

• VOYA - LTD Basic Plan – Full Time and Part Time

• VOYA - LTD Basic Plan - Local 73 and Local 743

• VOYA - LTD Basic Plan - Physicians

• VOYA - LTD Optional Plan – Full Time and Part Time

• VOYA - LTD Optional Plan - Local 73 and Local 743

• VOYA - LTD Optional Plan - Physicians

Medical

• Glossary of Coverage and Medical Terms

• Progyny Member Guide (HDHP and PPO)

• Progyny Surrogacy Assistance Program Summary

• Summary Plan Description - The University of Chicago Health Care Plans

• Ovia Health™ (HDHP and PPO)

• Flu Vaccines 2024

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 HDHP Maroon Savings Choice Plan - Benefit Book

• BCBS HDHP Maroon Savings Choice Plan - Contribution Payments and Deductible

• BCBS HDHP Maroon Savings Choice Plan - Summary of Benefits & Coverage

BCBS Blue Advantage HMO Plan

• BCBS Blue Advantage Plan- Benefit Book

• BCBS Blue Advantage Plan- Summary of Benefits & Coverage

• BCBS Blue Advantage Plan- Vision Booklet

• BCBS Blue Advantage Plan- Current Carrier Network

BCBS PPO Maroon Plan

• BCBS PPO Maroon Plan - Benefit Book

• BCBS PPO Maroon Plan - Summary of Benefits & Coverage

University of Chicago Health Plan (UCHP)

• University of Chicago Health Plan (UCHP) Booklet

• UCHP Schedule of Benefits

• UCHP Summary of Benefits & Coverage

• UCHP - CVS Minute Clinic

• UCHP - Need an ID Card

• UCHP - ScriptCenter

• UCHP - Women's Health Friends and Family Program

• Teladoc Health Diabetes Management

• Teladoc Health Hypertension Management

Prescription

CVS (BCBS PPO & HDHP, UCHP)

• Drug List - Advanced Control Formulary (PPO, HDHP, UCHP)

• Drug List - Specialty Advanced Control Formulary (PPO, HDHP, UCHP)

• Drug List - HDHP Preventive Drugs

• CVS Mail Service

• CVS Maintenance Choice Mandatory Opt-Out

• CVS Claim Form

• CVS Claim Form FAQs

• UCHP - States where DCAM is Licensed

Prime Therapeutics (BCBS HMO)

• Drug List - Prime Therapeutics Formulary

• Quarterly Changes - Prime Therapeutics Formulary

Permanent Life Insurance with Long Term Care

• Trustmark - Long Term Care

• Trustmark - Understanding Term Life and Permanent Life Insurance

• Trustmark - Universal LifeEvents with Long Term Care Benefit

• Trustmark - Universal Life Insurance with Long-Term Care Age 65-75

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 - Postponement Form (VSRI Only)

• Retiree Medical Plan - Enrollment Form

• Retiree Medical Plan - Postponement Form 

• Retiree Medical Plan - Cancellation Form 

Not Medicare Eligible (BCBS and UCHP)

• BCBS HDHP Maroon Savings Choice Plan

• BCBS HMO Illinois Plan

• BCBS PPO Maroon Plan

• University of Chicago Health Plan (UCHP)

Prescription Not Medicare Eligible (CVS)

• CVS - Advanced Control Formulary
• CVS - Advanced Control Specialty Formulary
• BCBS HMO IL - Prime Therapeutics Formulary

Medicare Eligible (Aetna)

• Aetna - Medicare Medical Claim Reimbursement Instructions

• Aetna - Services that Require Precertification

• Aetna - Medicare Advantage Plan Summary

Aetna Medicare Advantage

• Aetna - Additional Wellness Benefits

• Aetna - Continuity of Care Form

• Aetna - Enhanced Preventive Dental Value ESA

• Aetna - Evidence of Coverage

• Aetna - Explanation of Benefits Guide

• Aetna - Healthy at Home

• Aetna - How to Search for a Medicare Advantage Provider

• Aetna - Information for Nonparticipating Providers

• Aetna - Kidney Support

• Aetna - Medicare Advantage Handbook

• Aetna - Medicare Advantage Plan Summary

• Aetna - SilverSneakers GO App

• Aetna - SilverSneakers On-Demand

Aetna Medicare Supplement

• Aetna - Discount Program 

• Aetna - LifeMart Wellness 

• Aetna - Medicare Supplement Plan Summary

Prescription Medicare Eligible (SilverScript)

• SilverScript Formulary

• SilverScript - Medicare Part D Enrollment Form

• SilverScript - Summary of Benefits

Retirement Program

• 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

Summary Annual Report

• Summary Annual Report - Contributory Retirement Plan (CRP)

• Summary Annual Report - Retirement Income Plan for Employees (ERIP)

• Summary Annual Report - Supplemental Retirement Plan (SRP)

Summary of Material Modifications for CRP, ERIP, and SRP 

• Summary of Material Modifications for CRP, ERIP, and SRP

• Summary of Material Modification Effective 1-1-24 - CRP and ERIP LTD and ERIP Definition of Compensation

• Summary of Material Modifications for Employer Contribution Reinstatement (December 2021)

Vision

• VSP - Summary of Benefits

• VSP - Certificate of Coverage

• VSP - Notice of Privacy Practices

• BCBS Blue Advantage Plan- Vision Booklet

Additional Benefits

• Business Travel Accident Insurance (risk@uchicago.edu)

• Employee Assistance Program

• Legal Plan Overview

• Legal Plan FAQ

• Legal Plan Tax Prep & Filing

• Pet Insurance Booklet

• Pet Insurance FAQ

• Pet Awareness Month

• Perspectives Joining AllOne Health

• Perspectives International Services through Lyra

Related Links

• Annual Notices