By Subject
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Accidental Death and Dismemberment Plan
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ASE Child Care Reimbursement
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Buybacks
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COBRA
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Death of an Employee or Retiree
- 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
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Dental
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Dependent Care Flexible Spending Account (DepCare FSA)
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Direct Deposit
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Disability/Pregnancy Disability
- Basic Disability Certificate of Coverage
- Disability Benefits for Faculty Fact Sheet
- Disability Policy
- 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
- From Disability to Retirement Fact Sheet
- Guide to Filing for Disability
- Long-Term Disability Benefits Summary
- Partial Disability: Stay At Work/Return to Work Fact Sheet
- Pregnancy, Newborn Child and Adopted Child Fact Sheet
- Su Guía de Beneficios por Discapacidad en la UC
- Application for Disability Income (UCRS 156)
- Voluntary Long-Term Disability Certificate of Coverage
- Voluntary Short-Term Disability Certificate of Coverage
- Your Guide To UC Disability Benefits
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Domestic Partners
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Employment
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Faculty Information
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Family Changes (marriage, birth, etc.)
- Breastfeeding resources
- Family Changes Fact Sheet
- Pregnancy, Newborn Child and Adopted Child Fact Sheet
- Qualified Domestic Relations Orders For UCRP Members Who Terminate Their Marriage After Retirement
- Qualified Domestic Relations Orders for UCRP Members Who Terminate Their Registered Domestic Partnership Prior to Retirement
- Qualified Domestic Relations Orders (QDRO) Fact Sheet
- Qualified Domestic Relations Orders for UCRP Members Who Terminate Their Marriage Prior to Retirement
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Health Flexible Spending Account (Health FSA)
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Leaves
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Legal Plan
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Life Insurance
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Medical Plans
- Core Plan Booklet (2018)
- Core Summary of Benefits and Coverage (2018)
- Definitions and Required Documents
- Health Net Blue & Gold Plan Booklet (2018)
- Health Net Blue & Gold Summary of Benefits and Coverage (2018)
- Health Net Seniority Plus Plan Booklet (2018)
- Health Net Seniority Plus Summary
- Behavioral Health Booklet for Health Net Blue & Gold, Kaiser & WHA (2018)
- Infertility Benefits Fact Sheet
- Kaiser Permanente Booklet (2018)
- Kaiser Permanente Summary of Benefits and Coverage (2018)
- Kaiser Senior Advantage Booklet (2018)
- Kaiser Senior Advantage Summary
- A New Approach to Your Retiree Medical Benefits
- OptumRx Member Reimbursement Drug Claim Form
- OptumRx Plan Booklet for UC HSP (2017)
- OptumRx Plan Summary for UC HSP (2017)
- Plan Booklet Archive
- Retiree Health Eligibility Fact Sheet
- TRICARE for Life
- UC Care Behavioral Health Booklet (2016)
- UC Care Booklet (2018)
- UC Care Summary of Benefits and Coverage (2018)
- UC Healthcare Plan Notice of Privacy Practices - Self-Funded Plans
- UC High Option Coverage Summary (2018)
- UC High Option Prescription Drug Plan Booklet (2018)
- UC High Option Plan Booklet (2018)
- UC Health Savings Plan Booklet (2018)
- UC HSP Quiz
- UC Health Savings Plan Summary of Benefits and Coverage (2018)
- UC Medicare PPO Coverage Summary (2018)
- UC Medicare PPO Prescription Drug Plan Booklet (2018)
- UC Medicare PPO Plan Booklet (2018)
- UC Medicare PPO Without Prescription Drugs Plan Booklet (2018)
- WHA booklet (2018)
- WHA Summary of Benefits and Coverage (2018)
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Medicare
- Health Net Blue & Gold Creditable Coverage Notice
- Health Net Seniority Plus Creditable Coverage Notice
- Kaiser Permanente Senior Advantage Creditable Coverage Notice
- Medicare Fact Sheet
- Medicare Advantage Plan Disenrollment Form (UBEN 101)
- Blue Cross MedicareRx with Senior Rx Plus Enrollment Form for UC Medicare PPO or UC High Option Supplement to Medicare (UBEN 123)
- Medicare Advantage Enrollment/Election Form for Health Net/Seniority Plus (UBEN 125)
- Medicare Advantage Universal Enrollment/Election Form for Kaiser Senior Advantage (UBEN 127)
- UC High Option Supplement to Medicare Creditable Coverage Notice
- UC Medicare PPO Prescription Drug Plan Booklet (2018)
- UC Medicare PPO Plan Booklet (2018)
- UC Medicare PPO Plan Creditable Coverage Notice
- UC Medicare PPO Plan Without Prescription Drugs Plan Non-creditable Coverage Notice
- WHA creditable Coverage Notice
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Retirement
- 403b Summary Plan Description
- 415m Restoration Plan
- 415m Restoration Plan Summary Plan Description
- Complete Retirement Benefits Guide for Employees
- Direct Deposit for Retiree Monthly Benefits Fact Sheet
- From Disability to Retirement Fact Sheet
- Retiree Health Eligibility Fact Sheet
- Retirement Benefits Decision Guide for rehired, newly eligible and former CalPERS-covered employees
- Retirement Benefits Decision Guide
- Retirement Benefits Fact Sheet
- Retirement Handbook
- Returning to UC Employment After Retirement Fact Sheet
- Phased Retirement Program Contract (U290)
- Phased Retirement Program - General Release of Claims Form (U291)
- UC Retirement Choice Program—Pasos para Elegir Opciones de Pension u Opciones de Ahorro
- UC Retirement Choice Program—Steps for Electing Pension Choice or Savings Choice
- UCRP 1976 Tier Summary Plan Description
- UCRP Summary Plan Description (for Members Without Social Security)
- UCRP Summary Plan Description for 2013 Tier Members
- UCRP/CalPERS Reciprocity Fact Sheet
- UCRP/CalSTRS Concurrent Retirement Fact Sheet
- Direct Deposit for Monthly Benefits (UCRS 160)
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Retirement Savings Program
- 403b Summary Plan Description
- 457(b) Deferred Compensation Plan
- Complete Retirement Benefits Guide for Employees
- Defined Contribution Plan Summary Plan Description
- Minimum Required Distributions Fact Sheet
- Retirement Savings Program Information for Safe Harbor Participants
- Service Credit Buyback Information Request (UCRS 169)
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Tax Information
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Termination/Layoff
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University of California Retirement Plan (UCRP)
- 415m Restoration Plan
- 415m Restoration Plan Summary Plan Description
- Complete Retirement Benefits Guide for Employees
- Lump Sum Cashout Fact Sheet
- Qualified Domestic Relations Orders For UCRP Members Who Terminate Their Marriage After Retirement
- Qualified Domestic Relations Orders for UCRP Members Who Terminate Their Registered Domestic Partnership Prior to Retirement
- Qualified Domestic Relations Orders (QDRO) Fact Sheet
- Qualified Domestic Relations Orders for UCRP Members Who Terminate Their Marriage Prior to Retirement
- Retirement Handbook
- Special Tax Notice for UC Retirement Plan Distributions
- Tax Withholding Election (Nonresident Aliens) (UBEN 106 NR)
- Tax Withholding Election for UCRP Income (UBEN 106)
- Designation of Beneficiary - Employees (UBEN 116)
- Designation of Beneficiary - Retirees, Former Employees & Others (UBEN 117)
- Service Credit Verification Request (UBEN 132)
- Distribution Request - CAP Balance (UBEN 142 CAP)
- Distribution Request — Refund of Accumulations (UBEN 142)
- UCRP 1976 Tier Summary Plan Description
- UCRP Buyback Booklet (discontinued)
- UCRP Summary Plan Description (for Members Without Social Security)
- UCRP Summary Plan Description (for Tier Two Members)
- UCRP Safety Members Summary Plan Description
- UCRP Service Credit Purchase Guide
- UCRP Summary Plan Description for 2013 Tier Members
- UCRP/CalPERS Reciprocity Fact Sheet
- UCRP/CalSTRS Concurrent Retirement Fact Sheet
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Vision Plan
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