*New: Benefits Mobile App
*New Benefit: Plano CRX - No Prescription Copay
- 2020 Benefits Summary
- Airrosti Brochure
- Airrosti Video
- Doctor on Demand
- Employee Assistance Program
Medical Plan Summary
- Medical Benefits Summary
- Medical Claim Form
- Medical/Pharmacy Summary Plan Description
- Medical Plan Summary of Benefits and Coverage
- UHC Rates 2020
United Healthcare Pharmacy
United Healthcare Dental
United Healthcare Vision
- LASIK Promotion Discount
- Vision Benefits Summary
- Vision Claim Form
- Vision Summary Plan Description
- Hospital GAP Brochure
- Hospital GAP Claim Form
- Hospital GAP Electronic Consent Form
- Hospital GAP Enrollment Form
- Hospital Gap Mobile App
If newly enrolling or making a change, you are required to complete a Hospital GAP enrollment form.
Connect4Health Wellness Program
- Biometric Screening Form Opens a New Window.
- Biometric Screening Information Opens a New Window.
- Connect4Health Premium Incentive RequirementsTOpens a New Window. Opens a New Window.
- Opens a New Window.
Opens a New Window.T
- Weight Watchers at Work Opens a New Window.
Flexible Spending Account (FSA)
- FSA Brochure
- FSA Change Form Opens a New Window.
- FSA Claim Form
- FSA Dependent Care Claim Form
- FSA Summary Plan Description
FSA will no longer apply to over-the-counter medications without a prescription.
Long-Term Disability (LTD)
Short-Term Disability (STD)
- Group Worksite Disability Insurance Certificate
- Group Worksite Disability Insurance Policy Opens a New Window.
- Application/Subscription Agreement for Group Life Insurance Opens a New Window.
- Basic Life and AD&D Policy
- Basic Life and AD&D Certificate
- Voluntary Term Life Insurance Certificate
Changing Your Benefits