Skip to content

Active Employees

Forms, Documents & Legal Info

Health Care

Medical, Dental, Vision

Aetna Dental Claim Form

BCBSTX Claim Form

BCBS Global Core Program Claim Form (US Domestic)

BCBS Global Core Program Claim Form (European)

Express Scripts Claim Form

Express Scripts Getting Started with Home Delivery

Express Scripts Preferred Drug/Exclusion List

Express Scripts Preventive Drug List

VSP Claim Form

Health Savings Account (HSA)

HSA Transfer Request Form
Spending Accounts

Flexible Spending Accounts

  • Health Care FSA
  • Dependent Care FSA
  • Limited Purpose FSA

PayFlex Health Care Limited Purpose Claim Form

PayFlex Dependent and Health Care Claim Form
Income Protection
Group Universal Life

Group Universal Life Beneficiary Designation Form

International: MetLife Beneficiary Designation Form

Disability

  • Short-Term Disability
  • Long-Term Disability

LTD Evidence of Insurability Form

Basic Life - LTD Participant

LTD Beneficiary Designation Form

Unions

  • Basic Life
  • Optional Life
  • Basic AD&D
  • Occupational AD&D
  • Voluntary AD&D

Beneficiary Designation Form
Other
 

Domestic Partner Affidavit Form 

Payroll:

Direct Deposit Form

Income Tax Withholding Instructions

Federal Tax Withholding Calculator

Federal Tax Withholding Form (W-4)

State Tax Withholding Forms
Health Care

Medical, Dental, Vision

BCBS Global Core Program Brochure

BCBS Global Core Program: Locating a Provider

Express Scripts Getting Started with Home Delivery

Express Scripts Preferred Drug/Exclusion List

Express Scripts Preventive Drug List

Transparency in Coverage Rule – Machine Readable Files

VSP Member Claim Reimbursement Guidelines

Supplemental Health Care

  • Accident Insurance
  • Critical Illness Insurance
  • Hospital Indemnity Insurance

Accident Plan Summary

Critical Illness Plan Summary

Hospital Indemnity Plan Summary
Spending Accounts

Flexible Spending Accounts

  • Health Care FSA
  • Dependent Care FSA
  • Limited Purpose FSA

PayFlex Reimbursement Accounts Claim Filing Guidelines
Income Protection

Accidental Death & Dismemberment (AD&D)

  • Basic AD&D
  • Voluntary AD&D
  • Occupational AD&D (OAD&D)

Basic AD&D Summary Overview

Occupational AD&D Summary Overview

Zurich AD&D Conversion Process

Disability

  • Short-Term Disability
  • Long-Term Disability

Short-Term Disability Program Guide

Retirement
401(k) Savings Plan & Retirement Plan

Leaving Oxy Guide

Investment Fund Fact Sheets
Other
 

2023 Employee Benefits Guide 

Time Away Program Guide
Health Care

New Hire and Open Enrollment Notices

401(k) Savings Plan Automatic Enrollment Notice

CHIP Notice

Employee Rights Under FMLA

HIPAA Privacy Notice

New Health Insurance Marketplace Coverage Notice

Medical, Dental, Vision

Summary of Benefits and Coverage

Summary Plan Descriptions

Supplemental Health Care

  • Accident Insurance
  • Critical Illness Insurance
  • Hospital Indemnity Insurance

Accident Insurance High Plan Cert.

Accident Insurance Low Plan Cert.

Critical Illness Insurance Plan Cert.

Hospital Indemnity Insurance High Plan Cert.

Hospital Indemnity Insurance Low Plan Cert.

Spending Accounts

Flexible Spending Accounts

  • Health Care FSA
  • Dependent Care FSA
  • Limited Purpose FSA

Summary Plan Descriptions
OxyHealth

EAP

Summary Plan Descriptions

  • SPD will be updated and posted soon
Income Protection

Basic Life

Summary Plan Descriptions

Accidental Death & Dismemberment (AD&D)

  • Basic AD&D
  • Voluntary AD&D
  • Occupational AD&D (OAD&D)

Summary Plan Descriptions

Group Universal Life

Summary Plan Descriptions

Disability

  • Short-Term Disability (STD)
  • Long-Term Disability (LTD)

Short-Term Disability Program Guide

Summary Plan Descriptions
Retirement
401(k) Savings Plan

401(k) Fee Disclosure

401(k) – Oxy Stock Fund Prospectus

Limits and Contributions

Notice of Proposed Exemptions

Oxy EACA and QDIA Notices

Safe Harbor Special Tax Notice and Fee Disclosure

Summary Plan Descriptions
Retirement Plan

Retirement Plan Fee Disclosure

Summary Plan Descriptions
Other
 

2023 FAMLI Program Notice (Colorado)

OCC: Medicare Notice of Creditable Coverage

OCC: Medicare Notice of Non-Creditable Coverage

OPC: Medicare Notice of Creditable Coverage

Required Federal Notices: Actives, no Grandfather

Rights and Protections Against Surprise Medical Bills – Federal Disclosure

USERRA Notice

COBRA Cotinuation of Coverage Notice

WHCRA Notice

Summary of Benefits and Coverage


Summary Plan Descriptions

 

Summary Annual Reports