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Benefits Forms & Documents

2017 Employee Benefits Survey Summary
2024 CHIP Annual Notice
2024 HSRx Pharmacy List
2024 Notice of Creditable Coverage
2024-2025 Benefits Guide
2024-2025 HDHP Summary of Coverage
2024-2025 PPO Summary of Coverage
Add UMR Debit Card to Mobile Wallet
BH Teladoc Flier.pdf
Chartis Organ & Tissue Transplant Program
Children’s Health Insurance Program (CHIP)
2023 CHIP ANNUAL NOTICE.pdf
Connect Benefit - Nurse Navigator
Connect Benefit Flier
Consumer Accounts Mobile App
Debit Card Auto Substantiation
Dependent Care FSA Claim Form
Dependent Care FSA Overview
Employee Assistance Program (EAP)
FFCRA Benefit Request Form CHILD CARE
FFCRA Benefit Request Form ILLNESS
Find a VSP Provider (Instructions)
Flexible Benefit Information
Flexible Benefits Plan 7.1.2021 - FINAL.pdf
Flexible Spending Worksheet
General Medicine with Teladoc
Glossary of Medical Terms
Glossary of Health Coverage and Medical Terms
HIPAA Privacy Notice
HSA - Invest in Your Health
HSA FAQ
HSA Overview
HSA Year-Round Election Form
HSRx Home Delivery Brochure.pdf
Limited Purpose FSA Overview
Long-Term Care Certificate of Coverage (Plan Description)
Long-Term Disability Certificate of Coverage (Plan Description)
MaxAlert - RSV Vaccine.pdf
Medical and Limited Purpose FSA FAQ
Medical FSA Summary
MLS Dependent Care FSA Overview 07-2023.pdf
MLS FSA Overview 07-2023.pdf
MLS_HSA_FAQ_07 2023.pdf
MLS_HSA Overview_07 2023.pdf
MLS_Investing Your HSA Funds_07 2023.pdf
MLS_Limited Purpose Flexible Spending Guide_07 2023.pdf
MLS_LPFSA Overview_07 2023.pdf
Organ Transplant Flier
Preferred Lab Flier

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