Documents and forms

Documents and forms Required notices

Benefit documents

2023 Benefits Guide
2023 Total Rewards Overview
Domestic Partnership Certification Form
HIPAA Authorization for Release of Information

Health and wellness—UnitedHealthcare (UHC) medical

2022 SPD - UHC Choice Plan (EPO)
2022 SPD - UHC Choice Plus High Deductible Plan
2022 SPD - UHC Choice Plus Out of Area PPO Plan
2022 SPD - UHC Choice Plus Plan (PPO)
2023 SBC - UHC Choice Plan (EPO)
2023 SBC - UHC Choice Plus High Deductible Plan
2023 SBC - UHC Choice Plus Out of Area PPO Plan
2023 SBC - UHC PPO Choice Plus Plan (PPO)
2023 SBC - UHC PPO Hawaii
Summary of Material Modifications (2022)

Health and wellness—Kaiser medical

2022 EOC - Kaiser Northern California
2022 EOC - Kaiser Southern California
2022 SBC - Kaiser California
2022 SBC - Kaiser California Pier 9
2022 SBC - Kaiser Oregon
2023 SBC - Kaiser California
2023 SBC - Kaiser California Pier 9
2023 SBC - Kaiser Oregon

Health and wellness—Dental

2023 Aetna Dental DMO Benefits Summary
2023 Aetna Dental PPO Benefits Summary
Aetna Dental DMO Plan Booklet
Aetna Dental DMO Plan Booklet (Arizona)
Aetna Dental DMO Plan Booklet (California)
Aetna Dental DMO Plan Booklet (New Jersey)
Aetna Dental DMO Plan Booklet (North Carolina)
Aetna Dental DMO Plan Booklet (Texas)
Aetna Dental PPO Plan Booklet

Health and wellness—Vision

2023 VSP Benefits Summary
VSP Group Vision Care Plan EOC

Health and wellness—FSA and HSA

Optum Bank Health Savings Account (HSA) Midyear Change Guidelines
Optum Bank Health Savings Account (HSA) User Guide
Optum Bank terms and conditions

Health and wellness—Cigna global medical plan

Cigna SBC
Cigna SPD

Financial—Disability and life coverage

Prudential Accidental Death and Dismemberment (AD&D) Coverage
Prudential Life Coverage (Employees and Dependents)
Prudential Long-Term Disability (LTD) Coverage (Employees)
Prudential Long-Term Disability (LTD) Coverage (Interns)
Taxable Payout Agreement – AD&D
Taxable Payout Agreement – Long-Term Disability (LTD)

Time away

Discretionary Time Off (DTO) Philosophy and Q&A
Discretionary Time Off (DTO) Policy
Leave Policies
Sabbatical Policy
Vacation Policy

Everyday living

ARAG Legal Insurance Certificate and Service Plan
Commuter Check enrollment
Make a Family Claim Form