Human Resources - Employee Benefits

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2010 Open Enrollment
(September 8 - October 30, 2009)

2010 Active Employee Open Enrollment Guide (pdf)

2009 Publications

2009 Benefits & Enrollment Guide for Employees (68.6 MB)
Guía de Inscripción y Beneficios para los Empleados-2009 (879 KB)
2009 Three-Tier Prescription Drug List Reference Guide
Important Information about Your Pharmacy Benefits

2009 HRA Plan Design

Questions and Answers
Benefit Tools and Resources
       Health Benefits Calculator
How the Plan will Work
How to Use the HRA Plan
2009 Health Care Briefing

2009 Forms

Medical

Common-Law-Marriage Form (Dallas County Form; please visit your County Records
Building for this form)
Domestic Partnership Affidavit
Termination of Domestic Partnership
UnitedHealthcare Drug Mail Order Form

Life Insurance

UnitedHealthcare Specialty Benefits Conversion Request Form
UnitedHealthcare Specialty Benefits Beneficiary Designation/Change Form (En español)
UnitedHealthcare Specialty Benefits Death Benefit Claim Form
United Healthcare Specialty Benefits How to File Claims Information
United Healthcare Specialty Benefits Beneficiary Services Information
United Healthcare Specialty Benefits Accelerated Benefits Form
United Healthcare Specialty Benefits Will & Trust Information
United Healthcare Specialty Benefits Travel Assistance Information

Deferred Compensation

401(k) Plan Enrollment Guide
457 Plan Enrollment Guide

401(k) Retirement Savings Plan Beneficiary Designation Form 
457 Deferred Compensation Plan Beneficiary Designation Form
457 PST Plan Beneficiary Designation Form

Beneficiary Designation

Employees' Retirement Fund (ERF) Designee Form 
Dallas Police & Fire Pension (PFP) Designee Form
Active Employee Final Paycheck Beneficiary Designation Form

2009 PPO Plans - United Healthcare

75-25 PPO Plan – $1000/$2000 HRA Plan Summary of Benefits
70-30 PPO Plan - $3000 Deductible Plan Summary of Benefits

2009 EPO Plan

EPO Plan Summary of Benefits

UHC Dental PPO Covered Services
UHC Dental HMO Covered Services
Vision Plan - Spectera
Long-term Care Insurance - Metropolitan Life Group
Paycheck Protector - The Hartford

2009 Life Insurance Plans - UnitedHealthcare Specialty Benefits (see the life insurance section of the 2009 Benefits & Enrollment Guide for a description of this benefit)

Group Life Insurance Policy
Group Life Insurance Policy (En español)    

2009 Flexible Spending Accounts - United Healthcare

United Healthcare Flexible Spending Account (EMSP and DCAP)
Reimbursement Claim Form
Over-the-Counter (OTC) Medical Care Items eligible and Ineligible for
Reimbursement under UnitedHealthcare Plans

2009 Legislative Notices

HIPAA Privacy Notice
HIPAA Plan Amendment

2009 Vendor Web Sites and Customer Service Numbers

Archives

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2004