​​​​​​​​​​​​​​​​​​​​​​​

​ The following files are in Adobe pdf format unless otherwise noted. Please use Acrobat Reader 5.0 or higher to view these files. If the files do not display properly please click on the Acrobat Reader icon to download a more current version of Acrobat Reader.

OPEN ENROLLMENT 2012 (En esp​añol)

UPDATE: New Health Benefit Center – City Hall 1DS
The Human Resources Health Benefits Service Center has relocated to the first floor of City Hall, room 1D-South. The service center is open Monday through Friday from 8 a.m. to 5 p.m.

• For customer service, call 888.752.9122.

• For details regarding your benefits, you can also refer to the City of Dallas 2011 Active Employee Benefits & Enrollment Guide.

COVERAGE ALERT: New Mobile Apps

2011 Publications

2011 Active Employee Benefits & Enrollment Guide (pdf) (En español)
2011 Retiree Benefits & Enrollment Guide (pdf)
Tobacco Cessation Information (pdf)
Documentation Required for all Ins​​ured Dependents (pdf)

UHC’s new Pharmacy Benefit Manager (PBM) – Prescription Solutions

UHC has changed the City’s Pharmacy Benefit Manager from Medco to Prescription Solutions. Members enrolled in the 70/30/3000 and the 75/25/HRA plans will receive new Medical ID cards during the week of September 20, 2010. On October 1, discard your Medical ID card that lists Medco as the PBM and replace with the new card that lists Prescription Solutions as our new vendor.

2011 Specialty Pharmacy Pro​gram Brochure
2011 Prescription Solutions Mail Order Form
2011 UHC Prescription Solutions PDL

Employees and their family members enrolled in a UnitedHealthcare medical plan can obtain Tier 1 Diabetes Therapy Medications without having to meet their deductible first! If you are currently taking a Tier 2 or Tier 3 Diabetes Therapy Medication, and you are interested in discussing lower-cost alternatives with your doctor, we have provided a list that you can share with your physician. If changing your medications is not an option for you, Tier 2 and Tier 3 medications on the PDL would still be covered, they would just be at a higher out of pocket cost to you.

2011 Summary of Prescription Drug List C​hanges
2011 Tier 1 Diabetes Therapy Medications

2011 HRA Plan Design​

Benefit Tools and Resources
How to Use the HRA Plan

2011 Forms

Medical

Common-Law-Marriage Form (Dallas County Form; please visit your County Records 
Building for this form)

Life Insurance

United Healthcare Specialty Benefits Conversion Request Form 
United Healthcare Specialty Benefits Beneficiary Designation/Change Form (En español)
United Healthcare 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
United Healthcare Specialty Benefits AD&D Claim

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

2010 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

2011 Dental Plans

UHC Dental PPO Covered Services 
UHC Dental HMO Covered Services
UHC Dental EPO Covered Services

2011 Vision Plans

UHC Vision Plan

2011 Voluntary Benefits - Colonial Life and AFLAC (see the Voluntary Benefits Program section of the 2010 Benefits & Enrollment Guide for a description of each of these Non-City Sponsored Voluntary Benefits. You may contact Colonial at 1-800-325-4368 and AFLAC at 1-800-992-3522.).

Colonial Life Service Forms
AFLAC Service Forms

2011 Life Insurance Plans - UnitedHealthcare Specialty Benefits (see the life insurance section of the 2011 Benefits & Enrollment Guide for a description of this benefit)

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

2011 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

2011 Legislative Notices

HIPAA Privacy Notice 
HIPAA Plan Amendment

20111 Vendor Web Sites and Customer Service Numbers

​Archives​

2011
2010
2009
2008
2007
2006
2005
2004