Forms/Documents

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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	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
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 Investment Fund Fact Sheets

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 BCBSWNY Medical SPD Independent Health HMO Medical SPD Long-Term Disability 2020 SPD Long-Term Disability Beneficiaries/Dependents: Supplement to the Oxy Medical Plan SPD Long-Term Disability - 2015 SPD Long-Term Disability - 2010 SPD 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 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 FSA SPD
OxyHealth
EAP	Summary Plan Descriptions Lyra Employee Assistance Program
Income Protection
Basic Life	Summary Plan Descriptions Basic Life Insurance SPD
Accidental Death & Dismemberment (AD&D) Basic AD&D Voluntary AD&D Occupational AD&D(OAD&D)	Summary Plan Descriptions Basic AD&D SPD Voluntary AD&D SPD
Group Universal Life	Summary Plan Descriptions Group Universal Life SPD
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 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 503 OCC BCBS Hourly Employee Niagara SAR 504 OCC LTD SAR 511 OCC BCBS for Hourly EE North Tonawanda 600 OCC Medical Plan 501 Anadarko Petroleum Corp Health Benefits Plan 502 Anadarko Petroleum Corp Ancillary Benefits Plan 504 Anadarko Petroleum Retiree Health Benefits Plan