Human Resources - Employee Benefits

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2009 Publications

2009 Benefits & Enrollment Guide for Retirees (68.6 MB)
Guía de Inscripción y Beneficios para los Jubilados-2009 (879 KB)
2009 Three-Tier Prescription Drug List Reference Guide
Important Information about Your Pharmacy Benefits
Life Insurance Certificate (for retirees that retired after October 1, 1974 and before
January 1, 2002)

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

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

2009 Medicare Part D Plan

Summary of Prescription Drug Benefits
What's New with Medicare Part D

2009 Legislative Notices

HIPAA Privacy Notice
HIPAA Plan Amendment

2009 Vendor Web Sites and Customer Service Numbers

Archives

2008
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2005
2004