Health & Welfare Benefits

• Family support program overview
• Young adults and the behavioral health system
• Family support program flyer with boy
• Family support program flyer with girl

WEX Health is responsible for producing COBRA packets for all qualifying events.

Locations are required to report the following events via the WEX Health employer website:

• Divorce/legal separation/annulment
• Termination of domestic partnership
• Dependent's loss of eligibility
• Leave of absence
• Reduction of hours

UC Office of the President will report all terminations and deaths of employees to WEX Health via electronic file. Locations will not need to report or take any action for these events.

• 2021 COBRA Rates & Tip Sheet
• 2020 COBRA Rates & Tip Sheet
• 2019 COBRA Rates & Tip Sheet
• 2018 COBRA Rates & Tip Sheet
• 2017 COBRA Rates & Tip Sheet
• 2016 COBRA Rates & Tip Sheet
• 2015 COBRA Rates & Tip Sheet
• 2014 COBRA Rates & Tip Sheet
• 2013 COBRA Rates & Tip Sheet
• 2012 COBRA Rates
• COBRA Notice of Unavailability

• Overage Disabled Child Carrier Certification
• Anthem: Request to Continue Dependent Coverage form
• Health Net: Disabled Dependent Certification form
• Kaiser Permanente: Kaiser Permanente modifies its Disabled Dependent Enrollment Application form periodically. Kaiser members are advised to call the number on the back of their membership cards to request a mailed packet, which will include the current application form.

• Accidental Death & Dismemberment
• Dental
• Disability
• Flexible Spending Accounts
• Legal
• Life Insurance
• Medical
• Tax Savings on Insurance Premiums
• Vision

• Part I — Introduction (Preface, Definitions and Abbreviations)
  • Administrative Supplement to Part I
    • I-A Appeal Procedures
• Part II — General Eligibility Provisions
  
  • Administrative Supplements to Part II
    • II-A Eligibility Requirements
    • II-B Qualifying Retirement Plans for Employee Health & Welfare Eligibility
    • II-C Procedures for Continuing Coverage Via Direct Pay
    • II-D Continuation of Coverage — Overage Disabled Children
    • II-E Break in Service
    • II-F DepCare FSA Program for Academic Student Employees and Graduate Student Researchers
    • II-G Health Insurance Assignment Orders and National Support Notices
    • II-H Family Member Eligibility Verification
    • II-I The Lookback Measurement
• Part III — Faculty/Staff Health and Welfare Benefits
  
  • Administrative Supplements to Part III
    • III-A Medical Plan Contingency Fund for Worker’s Compensation
    • III-B Annual Base Benefit Rate
    • III-C Short Work Break
• Part IV — Annuitant Health & Welfare Benefits
  • Medical & Dental (Section 6000)
  • Medicare Coordinator Program
  • Legal
  • Vision
  • AD&D
• Part V – Postdoctoral Scholar Health and Welfare Benefits 

• Appendix — University of California Section 125 Plan

Annuitant Administrative Supplements

• 07 — Annuitant Open Enrollment Period
• 11 — Reappointed Retirees — Benefits Eligibility & Procedures
• 12 — Retiree Medical & Dental Eligibility Upon Rehire
• 17 — Annuitant Medical & Dental Coverage Under One-Time Service Credit Allocation
• 22 — Annuitant Medical Insurance & Medicare (under review)
• 25 — Impact of Howard Hughes Medical Institute Service on Eligibility for UC Retiree Insurance

• Privacy Notice (2014)

2017

• Core SBC
• Health Net Blue & Gold SBC
• Kaiser Permanente SBC
• UC Care SBC
• UC Health Savings Plan SBC
• UC Health Savings Plan OptumRx summary
• UC High Option summary
• UC Medicare PPO summary
• Western Health Advantage SBC

2015

• Core SBC
• Core SBC (Spanish)
• Core Benefit Summary
• Health Savings Plan SBC
• Health Savings Plan SBC (Spanish)
• Medicare High Option Benefit Summary
• Medicare PPO Benefit Summary
• Medicare PPO without Rx Benefit Summary

2014

• Core SBC
• Health Reimbursement Account (HRA) SBC
• Health Savings Plan SBC

• Medicare Part D Creditable Coverage Notice (2020)
• Medicare Part D Creditable Coverage Notice (2019)
• Medicare Part D Creditable Coverage Notice (2018)
• Medicare Part D Creditable Coverage Notice (2017)

Employees may estimate their premiums for Voluntary Short-Term and/or Long-Term Disability Insurance and for Supplemental Life Insurance and Dependent Life Insurance using the estimator tools below:

• Premium Estimator for Disability Insurance (2023)
• Premium Estimator for Disability Insurance (2022)
• Premium Estimator for Life Insurance

• Prudential Portal for Benefits Offices
• Evidence of Insurability (Long Form)
• Continuing Group Life Insurance Coverage
• Portability Forms (2017)
• Portability Plan Rates (2017)
• Accelerated Benefit Option Form for the Employee
• Beneficiary Statement (2017)
• Administrative Manual (2015)
• Beneficiary Statement (2012)
• Conversion Rates (2009)
• Conversion Form (2008)
• Portability Plan Rates (2008)
• Booklet archive

• UBEN 154 - Rider Enrollment - Voluntary Disability Continuation
• Report your claim online
• Reporting your disability claim

Archive of past disability policies

• Disability policy (1997-1999)
• Disability policy (Jan. 1-April 1, 2000)
• Disability policy (Apri 1, 2000-Jan. 1, 2001)
• Disability policy (2001-2004)
• Disability policy (2005-2013)
• Disability policy (2014-July 1, 2016)
• Disability policy (July 1, 2016-Jan. 1, 2017)

• AD&D Plan Booklet for Employees
• AD&D Plan Booklet for Retirees
• AD&D Retiree Enrollment Form