By Title
A
- Academic Appointee Summer Salary Benefit Fact Sheet
- Academic Student Employee and Graduate Student Researcher Childcare Reimbursement (UBEN 254)
- Accelerated Benefit Option Form
- Accident Certificate of Insurance
- AD&D Plan Booklet for Employees
- AD&D Plan Booklet for Retirees
- Address Change Notice (UBEN 131)
- Adoption Assistance Plan Claim Form
- Adoption Assistance Plan Policy
- Adoption Assistance Plan Verification Form
- Affidavit of Overage Disabled Child Eligibility
- Affidavit of Unregistered Domestic Partner Eligibility
- Amendment to AD&D agreement
- Application for Disability Income (UCRS 156)
- Application for No Lapse in Pay option (UCRS 168)
- ARAG Plan Booklet
- ASE and GSR Child Care Reimbursement Program Fact Sheet
B
- Basic Disability Benefits Summary
- Basic Disability Benefits Summary (Spanish)
- Basic Disability Certificate of Coverage
- Being laid off
- Benefits for Domestic Partners
- Benefits of Belonging
- Breastfeeding resources
C
- Changes to Your Retiree Medical Benefits
- Childrens Health Insurance Program Model Notice
- COBRA Rates & Tip Sheet
- COBRA Rates & Tip Sheet (2020)
- Complete Guide to UC Health and Welfare Benefits
- Complete Retirement Benefits Guide for Employees
- CONEXIS Guide to Expenses
- CORE Benefits Summary
- CORE Plan Booklet
- CORE Plan Booklet (2023)
- CORE Prescription Drug Plan Summary Plan Description
- CORE Prescription Drug Plan Summary Plan Description (2023)
- CORE Prescription Drug Summary Plan Description
- Critical Illness Certificate of Insurance
D
- DC Plan Regulations
- Declaration of Domestic Partnership (UBEN 250)
- Declaration of Tax Dependency (UPAY 886)
- Defined Contribution Plan Summary Plan Description
- Definiciones y Documentos Requeridos - Family Member Verification
- Definitions and Required Documents
- DeltaCare Plan Booklet
- DeltaCare Plan Booklet (2023)
- DeltaCare Plan Summary
- DeltaCare Plan Summary (2023)
- Delta Dental Plan Highlights
- Delta Dental PPO Plan Booklet
- Delta Dental PPO Plan Booklet (2023)
- Delta Dental PPO Plan Highlights (2023)
- Demographic Data Transmittal SP
- DepCare FSA Claim Form (WageWorks)
- DepCare FSA Enrollment, Change, or Cancellation Salary Reduction Agreement - for Academic Student Employees (UPAY 919-ASE/GSR)
- DepCare FSA Summary Plan Description
- DepCare FSA Summary Plan Description for Postdoctoral Scholars
- Dependent Care FSA for Academic Student Employees
- Designation of Alternate Beneficiary (UBEN 119)
- Designation of Beneficiary - Employees (UBEN 116)
- Designation of Beneficiary - Retirees, Former Employees & Others (UBEN 117)
- Direct Deposit for Monthly Benefits (UCRS 160)
- Direct Deposit for Retiree Monthly Benefits Fact Sheet
- 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
- Distribution Request - CAP Balance (UBEN 142 CAP)
- Distribution Request — Refund of Accumulations (UBEN 142)
- Document Submission Steps
- Domestic Relations Orders (DRO) Fact Sheet
- Domestic Relations Orders (DROs)
E
- Election to Change Primary Retirement Benefit from Savings Choice to Pension Choice (UCRS 216)
- Eligibility Appeal Form for Health & Welfare Benefits Plans (UBEN 177)
- Enrollment Form for UC Medicare Choice (UBEN 121)
- ERIT Contract
- ERIT Contract Amendment
F
- Family & Medical Leave Fact Sheet
- Family Changes Fact Sheet
- Family Member Eligibility Verification FAQ
- From Disability to Retirement Fact Sheet
- FSA Claim Form (WEX)
G
H
- Health Care Facilitator Program
- Health Care FSA Summary Plan Description for Postdoctoral Scholars
- Health FSA Claim Form (WageWorks)
- Health FSA Summary Plan Description
- Health Net Seniority Plus out of area list
- Hospital Indemnity Certificate of Insurance
I
- Infertility Benefits Fact Sheet
- Instructions for Online Submission of Evidence of Insurability
- Instructions for Online Submission of Evidence of Insurability
- Instructions for Online Submission of Evidence of Insurability (Spanish)
- International ACH Transaction Form
K
- Kaiser HMO Summary of Benefits and Coverage
- Kaiser Permanente Booklet
- Kaiser Permanente HMO Booklet (2023)
- Kaiser Permanente Senior Advantage Creditable Coverage Notice
- Kaiser Permanente Senior Advantage out-of-area list
- Kaiser Senior Advantage Booklet
- Kaiser Senior Advantage Booklet (2023)
- Kaiser Senior Advantage Summary
L
- Leave Without Pay Fact Sheet
- Legal Insurance from ARAG Highlights
- Legal Insurance from ARAG plan summary
- Legal Insurance from ARAG plan summary (Spanish)
- Life Insurance Guaranty Association Notices
- Life Insurance Plan Booklet
- Lincoln Basic Disability Benefits Summary (2023)
- Lincoln Long-Term Disability Benefits Summary (2023)
- Lincoln Short-Term Disability Benefits Summary (2023)
- Long-Term Disability Benefits Summary
- Long-Term Disability Benefits Summary (Spanish)
- Lump Sum Cashout Fact Sheet
M
- Medical Coverage Opt Out During Pandemic (UBEN 230)
- Medicare Advantage Plan Disenrollment Form (UBEN 101)
- Medicare Advantage Universal Enrollment/Election Form for Kaiser Senior Advantage (UBEN 127)
- Medicare Fact Sheet
- Minimum Required Distributions Fact Sheet
N
- Navitus (PDP) Enrollment Form for UC Medicare PPO or UC High Option Supplement to Medicare (UBEN 123)
- Navitus MedicareRx (PDP) Evidence of Coverage
- Notice to UC of a COBRA Qualifying Event (UBEN 109)
O
- Optum Behavioral Health Booklet (2023)
- Optum Behavioral Health Plan Booklet
- Optum Behavioral Health Summary of Benefits and Coverage
- Optum Behavioral Health Summary of Benefits and Coverage (2023)
- Overview of UC Benefits for Tenure-Track Faculty
P
- Paid leave
- Partial Disability: Stay At Work/Return to Work Fact Sheet
- Pension Choice Covered Compensation Limit for Reciprocal CalPERS Classic Members (UBEN 300)
- Personal Accident Insurance Plan
- Plan Booklet Archive
- Postdoctoral Scholars Benefits Plan Transgender Health Benefits Fact Sheet
- Postdoctoral Scholars Child Care Reimbursement Factsheet
- Pregnancy, Newborn Child and Adopted Child Fact Sheet
- Pretax Transportation Program Fact Sheet and Form
Q
R
- Request Form for Retroactive Use of 2021 EPSL
- Request for Retirement Initiation Packet
- Retiree AD&D Enrollment Form
- Retiree Continuation, Enrollment, or Change - Medical, Dental, &/or Legal Plan (UBEN 100)
- Retirement Benefits Decision Guide
- Retirement Benefits Decision Guide for rehired, newly eligible and former CalPERS-covered employees
- Retirement Benefits Fact Sheet
- Retirement Handbook
- Retirement Savings Program Information for Safe Harbor Participants
- Returning to UC Employment After Retirement Fact Sheet
S
- Savings Choice participants: Your opportunity to switch to Pension Choice
- ScholarShare Payroll Deduction Form
- Seguro legal de ARAG (2023)
- Seguro legal de ARAG puntos principales
- Service Credit Purchase Information Request (UCRS 169)
- Service Credit Verification Request (UBEN 132)
- Short-Term Disability Benefits Summary
- Short-Term Disability Benefits Summary (Spanish)
- Special Tax Notice for UC Retirement Plan Distributions
- 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)
- Su Guía de Beneficios por Discapacidad en la UC
- Summary of Benefits and Coverage
- Summary of Benefits and Disclosure Form
- Supplemental Health Plans Guide
- Supplemental Health Plans Guide
- Supplemental Health Plans Guide (2021)
T
- Tax Withholding Election (Nonresident Aliens) (UBEN 106 NR)
- Tax Withholding Election for UCRP Income (UBEN 106)
- Temporary Layoff
- Termination of Domestic Partnership (UBEN 253)
- Termination of Employment Benefits Fact Sheet
- The Roth option in the UC Retirement Savings Program
- Tobacco Cessation Resources
- Transgender Health Benefits Fact Sheet
- TRICARE for Life
- Trustee-to-Trustee Transfer Request for UCRP Service Credit (UCRS 186)
U
- U560/644 Multi-Location Appointment/Interlocation One-Time Payment Form
- UBEN 255
- UC Blue & Gold Summary of Benefits and Coverage
- UC Blue & Gold Summary of Benefits and Coverage (2023)
- UC Care Benefits Summary (2022)
- UC Care Prescription Benefit Booklet (2017)
- UC Care Prescription Drug Plan Summary Plan Description
- UC Care Prescription Drug Plan Summary Plan Description (2023)
- UC Care Summary of Benefits and Coverage (2021)
- UC Healthcare Plan Notice of Privacy Practices - Self-Funded Plans
- UC Health Savings Plan Benefits Summary (2022)
- UC Health Savings Plan Booklet
- UC Health Savings Plan Booklet (2019)
- UC Health Savings Plan Booklet (2023)
- UC Health Savings Plan Prescription Drug Plan Summary Plan Description
- UC Health Savings Plan Prescription Drug Plan Summary Plan Description (2023)
- UC Health Savings Plan Summary of Benefits and Coverage
- UC High Option Coverage Summary
- UC High Option PDP Coverage Summary (2023)
- UC High Option Plan Booklet
- UC High Option Plan Booklet (2023)
- UC High Option Prescription Drug Plan Evidence of Coverage
- UC High Option Supplement to Medicare Creditable Coverage Notice
- UC HSP Quiz
- UC Medicare Choice Benefits Summary
- UC Medicare Choice Complete Drug List (2023)
- UC Medicare Choice Plan Booklet
- UC Medicare Choice Plan Guide
- UC Medicare PPO Coverage Summary
- UC Medicare PPO PDP Coverage Summary (2023)
- UC Medicare PPO Plan Booklet
- UC Medicare PPO Plan Booklet (2023)
- UC Medicare PPO Plan Creditable Coverage Notice
- UC Medicare PPO Plan Without Prescription Drugs Plan Non-creditable Coverage Notice
- UC Medicare PPO Prescription Drug Plan Evidence of Coverage
- UC Medicare PPO Summary of Benefits (2020)
- UC Medicare PPO without Prescription Drugs Booklet
- UC Medicare PPO without Prescription Drugs Booklet (2023)
- UC Medicare PPO without Prescription Drugs Summary of Benefits
- UC Medicare PPO without Prescription Drugs Summary of Benefits
- 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/CalPERS Reciprocity Fact Sheet
- UCRP/CalSTRS Concurrent Retirement Fact Sheet
- UCRP 1976 Summary Plan Description (for Members Without Social Security)
- UCRP 1976 Tier Summary Plan Description
- UCRP Safety Members Summary Plan Description
- UCRP Service Credit Purchase Guide
- UCRP Special Durable Power of Attorney fact sheet
- UCRP Summary Plan Description (for Tier Two Members)
- UCRP Summary Plan Description for 2013 Tier Members
V
- Via Benefits Frequently Asked Questions
- Voluntary Long-Term Disability Certificate of Coverage
- Voluntary Self-Identification of Race, Ethnicity and Veteran Status (U5605)
- Voluntary Short-Term Disability Certificate of Coverage
- VSP Plan Booklet
- VSP Plan Booklet (2023)
- VSP Plan Summary for Employees
- VSP Plan Summary for Employees (2023)
- VSP Plan Summary for Retirees
- VSP Plan Summary for Retirees (2023)
W
- Welcome Kit
- WHA copay summary
- WHA creditable Coverage Notice
- Which Medical Plan is Right for You?
- Which medical plan is right for you? (8.5 x 11)
- Which Medicare Plan is Right for You?
- Which Medicare Plan Is Right for You? (8.5 x 11)
Y
- Your benefits at a glance
- 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 Former UC Employees
- Your Guide to Survivor & Beneficiary Benefits for Family Members & Beneficiaries of UC Retirees & Disabled Members Receiving UCRP Income
- Your Guide To UC Disability Benefits