By Category
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Fact Sheets
- 415m Restoration Plan
- Academic Appointee Summer Salary Benefit Fact Sheet
- ASE and GSR Child Care Reimbursement Program Fact Sheet
- Being laid off
- Dependent Care FSA for Academic Student Employees
- Direct Deposit for Retiree Monthly Benefits Fact Sheet
- Disability Benefits for Faculty Fact Sheet
- Disability Return-to-Work Fact Sheet - member after April 1, 1980
- Disability Return-to-Work Fact Sheet - member before April 1, 1980
- Disability Return-to-Work Fact-Sheet - safety members
- Family Changes Fact Sheet
- Family & Medical Leave Fact Sheet
- From Disability to Retirement Fact Sheet
- Group Insurance Eligibility Fact Sheet for Retirees
- Infertility Benefits Fact Sheet
- Leave Without Pay Fact Sheet
- Lump Sum Cashout Fact Sheet
- Medicare Fact Sheet
- Paid leave
- Partial Disability: Stay At Work/Return to Work Fact Sheet
- Postdoctoral Scholars Benefits Plan Transgender Health Benefits Fact Sheet
- Pregnancy, Newborn Child and Adopted Child Fact Sheet
- Pretax Transportation Program Fact Sheet and Form
- Domestic Relations Orders (DRO) Fact Sheet
- Retirement Benefits Fact Sheet
- Returning to UC Employment After Retirement Fact Sheet
- Savings Choice participants: Your opportunity to switch to Pension Choice
- Su Guía de Beneficios por Discapacidad en la UC
- Temporary Layoff
- Termination of Employment Benefits Fact Sheet
- Tobacco Cessation Resources
- Transgender Health Benefits Fact Sheet
- TRICARE for Life
- UCRP/CalPERS Reciprocity Fact Sheet
- UCRP/CalSTRS Concurrent Retirement Fact Sheet
- Your Guide To UC Disability Benefits
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Plan Booklets for UC-Sponsored Health and Welfare Plans
- AD&D Plan Booklet for Employees
- AD&D Plan Booklet for Retirees
- Legal Insurance from ARAG Highlights
- Seguro legal de ARAG puntos principales
- ARAG Plan Booklet
- Basic Disability Certificate of Coverage
- CORE Benefits Summary
- CORE Plan Booklet
- CORE Prescription Drug Summary Plan Description
- DeltaCare Plan Booklet
- Delta Dental PPO Plan Booklet
- DeltaCare Plan Summary
- Disability Policy
- Kaiser Permanente Booklet
- Kaiser HMO Summary of Benefits and Coverage
- Kaiser Senior Advantage Booklet
- Kaiser Senior Advantage Summary
- Life Insurance Plan Booklet
- Optum Behavioral Health Plan Booklet
- Optum Behavioral Health Summary of Benefits and Coverage
- Plan Booklet Archive
- Basic Disability Benefits Summary
- Supplemental Health Plans Guide
- Supplemental Health Plans Guide (2021)
- Supplemental Health Plans Guide
- UC Care Benefits Summary (2022)
- UC Health Savings Plan Benefits Summary (2022)
- UC High Option Prescription Drug Plan Evidence of Coverage
- UC High Option Plan Booklet
- UC Health Savings Plan Booklet
- UC Health Savings Plan Summary of Benefits and Coverage
- UC Medicare Choice Plan Booklet
- UC Medicare Choice Plan Guide
- UC Medicare Choice Benefits Summary
- UC Medicare PPO without Prescription Drugs Summary of Benefits
- UC Medicare PPO Prescription Drug Plan Evidence of Coverage
- UC Blue & Gold Summary of Benefits and Coverage
- VSP Plan Booklet
- Voluntary Long-Term Disability Certificate of Coverage
- Voluntary Short-Term Disability Certificate of Coverage
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Forms and Worksheets
- Accelerated Benefit Option Form
- Adoption Assistance Plan Claim Form
- Adoption Assistance Plan Verification Form
- DepCare FSA Claim Form (WageWorks)
- Domestic Relations Orders (DROs)
- 2022 Emergency Paid Sick Leave (EPSL) Notice and Request Form
- ERIT Contract Amendment
- ERIT Contract
- FSA Claim Form (WEX)
- Health FSA Claim Form (WageWorks)
- International ACH Transaction Form
- Instructions for Online Submission of Evidence of Insurability (Spanish)
- Instructions for Online Submission of Evidence of Insurability
- Retiree AD&D Enrollment Form
- Voluntary Self-Identification of Race, Ethnicity and Veteran Status (U5605)
- U560/644 Multi-Location Appointment/Interlocation One-Time Payment Form
- Retiree Continuation, Enrollment, or Change - Medical, Dental, &/or Legal Plan (UBEN 100)
- Medicare Advantage Plan Disenrollment Form (UBEN 101)
- Tax Withholding Election (Nonresident Aliens) (UBEN 106 NR)
- Tax Withholding Election for UCRP Income (UBEN 106)
- Notice to UC of a COBRA Qualifying Event (UBEN 109)
- Designation of Beneficiary - Employees (UBEN 116)
- Designation of Beneficiary - Retirees, Former Employees & Others (UBEN 117)
- Designation of Alternate Beneficiary (UBEN 119)
- Enrollment Form for UC Medicare Choice (UBEN 121)
- Navitus (PDP) Enrollment Form for UC Medicare PPO or UC High Option Supplement to Medicare (UBEN 123)
- Medicare Advantage Universal Enrollment/Election Form for Kaiser Senior Advantage (UBEN 127)
- Address Change Notice (UBEN 131)
- Service Credit Verification Request (UBEN 132)
- Distribution Request - CAP Balance (UBEN 142 CAP)
- Distribution Request — Refund of Accumulations (UBEN 142)
- Medical Coverage Opt Out During Pandemic (UBEN 230)
- Declaration of Domestic Partnership (UBEN 250)
- Termination of Domestic Partnership (UBEN 253)
- Academic Student Employee and Graduate Student Researcher Childcare Reimbursement (UBEN 254)
- Pension Choice Covered Compensation Limit for Reciprocal CalPERS Classic Members (UBEN 300)
- UC Retirement Choice Program—Pasos para Elegir Opciones de Pension u Opciones de Ahorro
- UCRP Special Durable Power of Attorney fact sheet
- Application for Disability Income (UCRS 156)
- Direct Deposit for Monthly Benefits (UCRS 160)
- Application for No Lapse in Pay option (UCRS 168)
- Service Credit Purchase Information Request (UCRS 169)
- Trustee-to-Trustee Transfer Request for UCRP Service Credit (UCRS 186)
- Election to Change Primary Retirement Benefit from Savings Choice to Pension Choice (UCRS 216)
- Statement Concerning Your Employment in a University Position Not Covered by Social Security (UCRS 419)
- State Oath of Allegiance, UC Patent Policy and Patent Acknowledgment (UPAY 585)
- Declaration of Tax Dependency (UPAY 886)
- DepCare FSA Enrollment, Change, or Cancellation Salary Reduction Agreement - for Academic Student Employees (UPAY 919-ASE/GSR)
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Benefit Summaries and Handbooks
- Benefits for Domestic Partners
- Benefits of Belonging
- Breastfeeding resources
- Complete Guide to UC Health and Welfare Benefits
- CONEXIS Guide to Expenses
- DepCare FSA Summary Plan Description for Postdoctoral Scholars
- DepCare FSA Summary Plan Description
- Health Care FSA Summary Plan Description for Postdoctoral Scholars
- Health FSA Summary Plan Description
- Legal Insurance from ARAG plan summary (Spanish)
- Legal Insurance from ARAG plan summary
- CORE Prescription Drug Plan Summary Plan Description
- Navitus MedicareRx (PDP) Evidence of Coverage
- UC Care Prescription Drug Plan Summary Plan Description
- UC Health Savings Plan Prescription Drug Plan Summary Plan Description
- Changes to Your Retiree Medical Benefits
- Overview of UC Benefits for Tenure-Track Faculty
- Retirement Benefits Decision Guide for rehired, newly eligible and former CalPERS-covered employees
- Retirement Benefits Decision Guide
- Retirement Handbook
- Your Guide to Survivor & Beneficiary Benefits for Family Members & Beneficiaries of Former UC Employees
- Your Guide to Survivor & Beneficiary Benefits for Family Members & Beneficiaries of Active UC Employees
- Your Guide to Survivor & Beneficiary Benefits for Family Members & Beneficiaries of UC Retirees & Disabled Members Receiving UCRP Income
- UC Care Summary of Benefits and Coverage (2021)
- UC High Option Coverage Summary
- UC Medicare PPO Coverage Summary
- UCRP Service Credit Purchase Guide
- Which Medical Plan is Right for You?
- Which Medicare Plan is Right for You?
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UCRS Summary Plan Descriptions (SPDs)
- 403(b) Summary Plan Description
- 415m Restoration Plan Summary Plan Description
- 457(b) Deferred Compensation Plan
- Complete Retirement Benefits Guide for Employees
- Defined Contribution Plan Summary Plan Description
- UCRP 1976 Tier Summary Plan Description
- UCRP 1976 Summary Plan Description (for Members Without Social Security)
- UCRP Summary Plan Description (for Tier Two Members)
- UCRP Safety Members Summary Plan Description
- UCRP Summary Plan Description for 2013 Tier Members