Benefits - United States : Notices and Documents

Benefit Descriptions

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Compliance Notices

401(k) Summary Annual Report 2021

Annual Compliance Notice 2023

COVID 19 Notice of Temporary Summary of Benefit Changes UHC Medical Plans

Drug Free Workplace Policy February 2020

Flexible Spending Account Summary Annual Report 2021

Health and Welfare Summary Annual Report 2021

Health Care Reform_Exchange_Notice_2022

HIPAA Notice of Privacy Practices

Medicare Part D Creditable Coverage Notice 2022

Voya Certificate of Coverage D5831 Accident Insurance

Voya Certificate of Coverage D5837 Critical Illness

Voya Certificate of Coverage D5838 Hospitalization

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Forms

Delta Dental Claim Form

HealthEquity Transfer Request Form

HIPAA Disclosure Authorization

HIPAA Release of Information-Form Optum Behavioral Health

HSA Proof of Other Medical Coverage Form

Kaiser HMO HI Claim Form

Kaiser HMO N CA Claim Form

Kaiser HMO N. CA Emergency Claim Form

Kaiser HMO N. CA Pharmacy Refill Form

Mandatory State Forms Voya Accident

Mandatory State Forms Voya Critical Illness

Mandatory State Forms Voya Hosptialization Indemnity

Massage Therapy Claim Filing Instructions

New York Life: Evidence of Insurability Form

New York Life: Supplemental Life Affidavit of Disabled Dependent Child Form

New York Life: Supplemental Life Evidence of Insurability (EOI) Form

Norway-Member-Certificate

TRI-AD FSA Claim Form

UHC Gender Dysphoria Hair Removal and Voice Therapy Claim Form

UHC Health Insurance Claim Form

UHC HIPAA Disclosure Authorization Form Medical

Voya Coverage Rates – Employee

Voya Coverage Rates – Spouse/Child

Voya Portability Coverage Form – Employee

Voya Portability Coverage Form – Spouse/Child

VSP Out-of-Network Reimbursement Form

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New Hire Notices

401(k) Savings Plan Summary Plan Description (SPD) 2022

Health Care Reform_Exchange_Notice_2022

HIPAA Notice of Privacy Practices

Medicare Part D Creditable Coverage Notice 2022

Quick Links

UK AXA – Travel Insurance Handbook

State Specific Notices

2023 California Voluntary Disability Plan Benefits Rate and Limit Changes

2023 Colorado Paid Family Leave Medical Notice Poster

2023 Oregon Paid Leave Notice Poster

California Disabillity Leave EDD de2515

California Paid Family Leave EDD de2511

California Programs for Unemployed EDD de2320

California Rights of Victims of Domestic Violence, Sexual Assault and Stalking Notice

California San Francisco Fair Chance Ordinance 2022

California San Francisco Health Care Security Ordinance 2023

California VMW Voluntary Disability Plan Summary Plan Document (SPD) 2020

California Workers Compensation Notice

Connecticut Paid Leave – Notice of Employee Rights

District of Columbia Paid Family Leave Notice

Georgia Workers Compensation Bill of Rights

Georgia Workers Compensation Notice

Massachusetts Paid Family Leave Notice

New York Paid Family Leave Notice

San-Francisco-Fair-Chance-Ordinance

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Summary of Benefits Coverage

Form 1095C FAQs

Health & Welfare and Cafeteria Plan Summary Plan Description 2022

Kaiser HMO California Summary of Benefits & Coverage (SBC) 2022

Kaiser HMO Hawaii Summary of Benefits & Coverage (SBC) 2022

UHC HSA PPO Summary of Benefits & Coverage (SBC) 2022

UHC HSA PPO-Harvard Pilgrim Summary of Benefits & Coverage (SBC) 2022

UHC Traditional PPO Summary of Benefits & Coverage (SBC) 2022

UHC Traditional PPO-Harvard Pilgrim Summary of Benefits & Coverage (SBC) 2022

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Summary Plan Descriptions

401(k) Savings Plan Summary Plan Description (SPD) 2022

California VMW Voluntary Disability Plan Summary Plan Document (SPD) 2020

CVS Caremark Summary Plan Attachment 2020

Flexible Spending Account Summary Plan Description (SPD)

Kaiser HMO N. CA Chiropractic and Acupuncture Evidence of Coverage (EOC) 2021

Kaiser HMO N. CA Evidence of Coverage (EOC) 2021

New York Life: AD&D Certificate 2020

New York Life: Basic Life Certificate 2020

New York Life: Long Term Disability Summary Plan Description (SPD)

New York Life: Supplemental Life Amendment 2020

New York Life: Supplemental Life Certificate 2020

Short Term Disability Summary Plan Description (SPD) 2020

UHC HSA PPO Summary Plan Description (SPD) 2022

UHC Traditional PPO Summary Plan Description (SPD) 2022

Voya Certificate of Coverage Accident Insurance (2021)

Voya Certificate of Coverage Critical Illness (2021)

Voya Certificate of Coverage Hospitalization (2021)

Voya Certificate of Coverage Hospitalization (2023)

VSP Evidence of Coverage (EOC)

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Benefit Reminders and Legal Notices

Important action items and legal notifications for your US Benefit plans.

COBRA

Information for workers and their families who have lost their health benefits

Contacts

Complete list of VMware benefits and providers

Health Care Reform

Learn more about the Affordable Care Act and how Health Care Reform impacts you

Intern Benefits

An overview of the US Benefit options available to Paid Interns.

Key Benefit Terms

A glossary of commonly used terms related to your US Benefits.

New Hire Benefits

An overview of the US Benefit options available to New Hires.

Archive: 2023 US Benefits Open Enrollment

Important Benefit Updates for the 2023 plan year, Employee Contributions for health plans, listed enhancements and new services.

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Last Updated: 6 Jan 2023, 3:22 PM