Forms/Documents

Skip to content

Health Care
Medical, Dental, Vision	Aetna Dental Claim Form BCBSTX Claim Form Express Scripts Claim Form VSP Claim Form
Health Savings Account (HSA)	HSA Transfer Request Form
Spending Accounts
Flexible Spending Accounts Health Care FSA Dependent Care FSA	Inspira Financial Reimbursement Accounts Claim Filing Guidelines
Income Protection
Basic Life	International: MetLife Beneficiary Designation Form
Basic Life - LTD Participant	Basic Life - LTD Participant Beneficiary Designation Form
Group Universal Life	Group Universal Life Beneficiary Designation Form

Health Care
Medical, Dental, Vision	Express Scripts Getting Started with Home Delivery Express Scripts Preferred Drug/Exclusion List Transparency in Coverage Rule – Machine Readable Files VSP Member Claim Reimbursement Guidelines
Spending Accounts
Flexible Spending Accounts Health Care FSA Dependent Care FSA	Inspira Financial Reimbursement Accounts Claim Filing Guidelines
Income Protection
Accidental Death & Dismemberment (AD&D) Basic AD&D Occupational AD&D Voluntary AD&D	Basic AD&D Summary Overview Occupational AD&D Summary Overview Zurich AD&D Conversion Process
Retirement
401(k) Savings Plan & Retirement Plan	Leaving Oxy Guide 401(k) Plan Investment Options Retirement Plan Investment Options

Health Care
Medical, Dental, Vision	Summary of Benefits and Coverage BCBSTX HDHP SBC BCBSTX PPO SBC Summary Plan Descriptions Aetna Dental SPD BCBSTX HDHP SPD BCBSTX PPO SPD Long-Term Disability 2020 SPD Long-Term Disability Beneficiaries/Dependents: Supplement to the Oxy Medical Plan SPD Long-Term Disability - 2015 SPD (Effective 01-2009) Long-Term Disability - 2010 SPD (Includes 2018 Certificate) Express Scripts Prescription Drug SPD Vision SPD UHC SPD (Global Health Insurance Program)
Supplemental Health Care Accident Insurance Critical Illness Insurance Hospital Indemnity Insurance	Accident Insurance High Plan Certificate Accident Insurance Low Plan Certificate Critical Illness Insurance Plan Certificate Hospital Indemnity Insurance High Plan Certificate Hospital Indemnity Insurance Low Plan Certificate
Spending Accounts
Flexible Spending Accounts Health Care FSA Dependent Care FSA Limited Care FSA	Summary Plan Description FSA SPD
OxyHealth
EAP	Summary Plan Description Lyra Employee Assistance Program
Income Protection
Basic Life	Summary Plan Description Basic Life Insurance SPD
Accidental Death & Dismemberment (AD&D) Basic AD&D Voluntary AD&D Occupational AD&D(OAD&D)	Summary Plan Description Basic AD&D SPD Voluntary AD&D SPD
Group Universal Life	Summary Plan Description Group Universal Life SPD
Retirement
401(k) Savings Plan	Safe Harbor Special Tax Notice and Fee Disclosure
Other
	Notice and Severance Pay Plan Benefits Summary 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 Required Federal Notices: Active, with Grandfather HIPAA Privacy Notice HIPAA Special Enrollment Notice USERRA Notice COBRA Continuation of Coverage WHCRA Notice 1095-C for Retiree/Former Employees Summary Plan Descriptions Cafeteria Plan SPD Notice and Severance Pay Plan SPD Change in Control Severance Plan SPD Summary Annual Reports 001 OPC Savings SAR 060 OPC Retirement SAR 591 OPC Welfare Plan SAR 502 INDSPEC Group Insurance SAR 504 OCC LTD SAR 600 OCC Medical Plan 504 Anadarko Petroleum Retiree Health Benefits Plan