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Former Employees

Forms, Documents & Legal Info

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

PayFlex Reimbursement Accounts Claim Filing Guidelines

International: MetLife Beneficiary Designation Form

Income Protection

Group Universal Life

Group Universal Life Beneficiary Designation Form

Basic Life - LTD Participant

Basic Life - LTD Participant Beneficiary Designation Form

Health Care

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 Care FSA

Summary Plan Descriptions

OxyHealth

EAP

Summary Plan Descriptions

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

Retirement

401(k) Savings Plan

Notice of Proposed Exemptions

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

Summary Plan Descriptions

Summary Annual Reports