Benefits - United States : Notices and Documents

Benefit Descriptions

Compliance Notices

401(k) Summary Annual Report 2018

Annual Compliance Notice 2019

Annual Compliance Notice 2020

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

Drug Free Workplace Policy February 2020

Flexible Spending Account Summary Annual Report 2018

Form 1095 Code Definitions 2019

Form 1095 Frequently Asked Questions 2019

Form 1095 Frequently Asked Questions 2020

Health and Welfare Summary Annual Report 2018

Health Care Reform Exchange Notice 2019

Health Care Reform Exchange Notice 2020

HIPAA Privacy Notice

Medicare Part D Creditable Coverage Notice 2019

Forms

Adoption-Surrogacy-Reimbursement-form-1.30.2020

Adoption/Surrogacy Reimbursement Form

CIGNA Supplemental Life Affidavit of Disabled Dependent Child Form

CIGNA Supplemental Life Evidence of Insurability (EOI) Form

Delta Dental Claim Form

HealthEquity Transfer Request Form

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

TRI-AD FSA Claim Form

UHC Gender Dysphoria Hair Removal and Voice Therapy Claim Form

UHC Health Insurance Claim Form

UHC Massage Therapy Claim Form 03182020

VSP Out-of-Network Reimbursement Form

New Hire Notices

401(k) Savings Plan Summary Plan Description (SPD) 2019

Annual Compliance Notice 2019

Annual Compliance Notice 2020

Health & Welfare and Cafeteria Plan Summary Plan Description (SPD) 2020

Health Care Reform Exchange Notice 2019

Health Care Reform Exchange Notice 2020

HIPAA Privacy Notice

Medicare Part D Creditable Coverage Notice 2019

State Specific Notices

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 Health Care Security Ordinance 2019

California San Francisco Health Care Security Ordinance 2020

California VMW Voluntary Disability Plan Benefit Rate & Limit Changes 2019

California VMW Voluntary Disability Plan Benefit Rate & Limit Changes 2020

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

California Workers Compensation Notice

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

Summary of Benefits Coverage

Kaiser HMO HI Summary of Benefits and Coverage (SBC) 2020

Kaiser HMO N CA Summary of Benefits and Coverage (SBC) 2020

Kaiser HMO N.CA 2020 Benefit Plan Summary

UHC HSA PPO Harvard Pilgrim Summary of Benefits and Coverage (SBC) 2020

UHC HSA PPO Summary of Benefits and Coverage (SBC) 2020

UHC Traditional PPO Harvard Pilgrim Summary of Benefits and Coverage (SBC) 2020

UHC Traditional PPO Summary of Benefits and Coverage (SBC) 2020

US-Voluntary-Life-Benefit-Summary-2020

Summary Plan Descriptions

401(k) Savings Plan Summary Plan Description (SPD) 2019

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

CIGNA AD&D Certificate 2020

CIGNA Basic Life Certificate 2020

CIGNA Long Term Disability Summary Plan Description (SPD)

CIGNA Supplemental Life Amendment 2020

CIGNA Supplemental Life Certificate 2020

CVS Caremark Summary Plan Attachment 2020

Delta Dental Evidence of Coverage (EOC)

Flexible Spending Account Summary Plan Description (SPD)

Health & Welfare and Cafeteria Plan Summary Plan Description (SPD) 2020

Kaiser HMO HI Evidence of Coverage (EOC) 2020

Kaiser HMO N CA Chiropractic & Acupuncture Evidence of Coverage (EOC) 2020

Kaiser HMO N CA Evidence of Coverage (EOC) 2020

Short Term Disability Summary Plan Description (SPD) 2020

UHC HSA PPO Summary Plan Description (SPD) 2020

UHC Traditional PPO Summary Plan Description (SPD) 2020

VSP Evidence of Coverage (EOC)

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 2019 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 2019 US Benefit options available to New Hires.