Documents and forms

Documents and forms Required notices

Benefit documents

2024 Benefits Guide
2024 Total Rewards Overview
Domestic Partnership Certification Form
Group Welfare Plan and Summary Plan Description
HIPAA Authorization for Release of Information

Health and wellness—UnitedHealthcare (UHC) medical

2023 SPD - UHC Choice Plan (EPO)
2023 SPD - UHC Choice Plus High Deductible Plan
2023 SPD - UHC Choice Plus Out of Area PPO Plan
2023 SPD - UHC Choice Plus Plan (PPO)
2023 SPD - UHC Options PPO Plan (Hawaii Only)
2024 SBC - UHC Choice Plan (EPO)
2024 SBC - UHC Choice Plus High Deductible Plan
2024 SBC - UHC Choice Plus Out of Area PPO Plan
2024 SBC - UHC PPO Choice Plus Plan (PPO)
2024 SBC - UHC PPO Hawaii

Health and wellness—Kaiser medical

2023 EOC - Kaiser Northern California
2023 EOC - Kaiser Northern California (Pier 9)
2023 EOC - Kaiser Oregon
2023 EOC - Kaiser Southern California
2024 SBC - Kaiser California
2024 SBC - Kaiser California Pier 9
2024 SBC - Kaiser Oregon

Health and wellness—Dental

2024 Aetna Dental DMO Benefits Summary
2024 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

2024 VSP Benefits Summary
VSP Group Vision Care Plan EOC

Health and wellness—FSA and HSA

Health Savings Account (HSA) vs. Health Care Flexible Spending Account (FSA) FAQ
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

2024 SBC - Cigna Global Plan
SPD - Cigna Global Plan

Financial

Lincoln Life and AD&D Coverage (Basic)
Lincoln Life and AD&D Coverage (Optional)
Lincoln Long-Term Disability (LTD) Coverage
Taxable Payout Agreement – Long-Term Disability (LTD)
Voluntary Disability Insurance (VDI) Plan (CA Employees Only)

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

Legally required documents and notices

Cafeteria Plan with Flexible Spending Arrangement
Children’s Health Insurance Plan (CHIP) Notice
Federal Women’s Health and Cancer Rights Act of 1998
Group Welfare Plan Summary Annual Report (2022)
Health Insurance Marketplace Notice
HIPAA Notice of Special Enrollment
HIPAA Privacy Notice
Medicare Part D Notice of Creditable Coverage (2023-24)
Rights & Responsibilities under the Family and Medical Leave Act
State notice – California: SF Health Care Accountability Ordinance (HCAO) Know Your Rights
State notice – California: SF Health Care Accountability Ordinance (HCAO) Waiver Form
State notice – California: Right to Request California Family Rights Act (CRFA) Leave
State notice – California: Rights and Obligations as a Pregnant Employee
State notice – California: SF Public Health Emergency Leave
State notice – California: Sick Leave Notice (Non-Exempt Employees)
State notice – Colorado: Family and Medical Leave Insurance Program (FAMLI)
State notice – Connecticut: Paid Leave Acts
State notice – Illinois: Consumer Coverage Disclosures
State notice – Illinois: Paid Leave
State notice – Massachusetts: Paid Family and Medical Leave
State notice – New Jersey: Family Leave Act
State notice – New Jersey: Law Against Discrimination
State notice – New York: Disability Benefits
State notice – New York: Paid Family Leave
State notice – New York: Paid Family Leave Opt Out Form
State notice – Oregon: Paid Leave Overview
State notice – Washington, D.C.: Paid Family Leave
State notice – Washington: Paid Family & Medical Leave