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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
- LTD Income Insurance (Full Time and Part Time)
- LTD Income Insurance (Local 73 and 743)
- LTD Income Insurance (Physicians)
- How to file a Disability Claim
- LTD Call-in Instructions
- Long-Term Disability Conversion Request Form
- LTD Basic Plan - Local 73 and Local 743
- LTD Basic Plan - Physicians
- LTD Optional Plan – Full Time and Part Time
- LTD Optional Plan - Local 73 and Local 743
- LTD Optional Plan - Physicians
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 Privacy Practices Notice
- 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)
Drug List – HDHP Preventive Drugs
View PDFPrime Therapeutics (BCBS HMO)
Permanent Life Insurance/ Long-Term Care
Retiree Medical Plan
- 2026 Retiree Medical Guide
- 2026 SilverScript Summary of Benefits
- 2026-Q1 SilverScript Formulary
- 2026 Retiree Medical Summary of Changes Letter
- Aetna Retiree Medicare Plans Webinar Recording
- How to Apply Online for Medicare
- Medicare 101 - An Educational Event (Presentation)
- Medicare Part D Notice
- 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)
Drug List – HDHP Preventive Drugs
View PDFMedicare 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
Summary Annual Report
Summary of Material Modifications for CRP, ERIP, and SRP
Documents
Vision
Documents
Additional Benefits
Documents
- AllOne Health Mobile App
- Employee Assistance Program
- AllOne Health Summary Plan Description
- AllOne Health (Perspectives) International Services through Lyra
- Lyra Global Webinar Schedule 2026
- Business Travel Accident Insurance
- Legal Plan Overview
- Legal Plan FAQ
- Legal Plan Tax Prep & Filing
- MetLife Legal Certificate of Coverage
- MetLife Legal Certificate of Coverage - Plus Parents
- MetLife Legal Portability Information
- Pet Insurance Booklet
- Pet Insurance FAQ
- whiskerDocs Pet Telehealth Overview
- Forefront Family Informational Flyer