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Total Rewards forms and guides

Browse Forms and Guides or filter by topic, audience, or program.

Audience
Program
Topic
Document Type
 
Name/Description File type
2017 Benefits Guide (benefits guide for the 2017 calendar year)

A brief overview of the many benefits that comprise faculty and staff members’ total rewards package.

PDF
2017 benefits premiums

The 2017 benefits premiums are found within the 2017 Total Rewards guide.

PDF
2018 Benefits Guide (benefits guide for the 2018 calendar year)

An overview of the many of the insurance benefits enrollment process.

PDF
2018 benefits premiums

The 2018 benefits premiums are found within the 2018 Insurance Benefits guide.

PDF
2018 comparison charts

The 2018 medical plan comparison chart can be found as part of the 2018 Insurance Benefits guide.

PDF
Custom Network Plan slicksheet

One-page summary of the Custom Network Plan offered by University of Missouri System.

PDF
Healthy Savings Plan slicksheet

One-page summary of the Healthy Savings Plan offered by UM System.

PDF
PPO Plan slicksheet

One-page summary of the PPO Plan offered by the University of Missouri System.

PDF
2017 comparison charts

The 2017 medical plan comparison chart can be found as part of the 2017 Total Rewards guide.

PDF
Tiered PPO Plan - UMKC - Summary of benefits and coverage (SBC) for calendar year 2018

For employees at UMKC: Summary of benefits and coverage document (SBC) for the PPO Plan (with tiered feature) for 2018.

PDF
Benefits Change Form for calendar year 2017

Use this form to change your insurance elections due to a family status change for the 2017 calendar year. This form cannot be used during the period of Annual Enrollment.

PDF
Benefits Enrollment Form for calendar year 2017

Benefits Enrollment Form to be used for initial benefit enrollment by new employees or by employees newly eligible for insurance. Must be received within 31 days of eligibility. This form cannot be used during Annual Enrollment.

PDF
Retiree Benefits Change Form and Retiree Beneficiary Designation Information (combo pack of forms)

Combo pack of forms, including: (1) Retiree benefits enrollment/change form to be used to change insurance elections. (2) Beneficiary designations form for basic life, supplemental life, and accidental death and dismemberment plans. Cannot be used during retirees’ Annual Enrollment period.

Note: The retiree beneficiary designation form is available on pg. 3.

PDF
Medical claim form for active employees (UHC)

Instructions on accessing the medical claim form for active employees under university medical insurance plans. UnitedHealthcare is the administrator.

Other
Proof of relationship requirement

Proof of relationship requirements to confirm the individual or individuals to be covered are eligible under the specific definitions of the plans.

PDF
University of Missouri Affirmation of Sponsored Adult Dependent Partnership

Form for establishing a sponsored adult dependent relationship for the purpose of university benefits

PDF
Medical claim form for retirees (Coventry) for 2016

Medical claim form for retirees under university medical insurance plans for calendar year 2016. Coventry is the administrator.

PDF
Prescription drug mail-in form

Express Scripts prescription drug mail-in order form.

PDF
University of Missouri Affidavit of Termination of Sponsored Adult Dependent Partnership

Use this form to terminate a sponsored adult dependent relationship for university benefits

PDF
Release of health information form (HIPAA)

Form for authorization of release of personal health information under HIPAA.

PDF
Custom Network Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the university Custom Network Plan for 2017.

PDF
Healthy Savings Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the university Healthy Savings Plan for 2017.

PDF
PPO Plan Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the university PPO Plan for 2017.

PDF
Retiree Health PPO Plan Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the Retiree Health PPO Plan for 2017.

PDF
Retiree Healthy Savings Plan Summary Plan Description (SPD) for calendar year 2017

Summary plan description for the Retiree Healthy Savings Plan for 2017.

PDF
What You Need to Know About Your Medicare Advantage Plan: 2017 Plan Guide

The enrollment guide for retirees and dependents enrolling in the university-sponsored Medicare Advantage Base Plan or Medicare Advantage Enhanced Plan. This document was produced and distributed by UnitedHealthcare, who is delivering the university-sponsored Medicare Advantage group plans. This document is for the 2017 calendar year, and provides both Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC) information for the two Medicare Advantage plans.

PDF
2017 preferred drug formulary - Medicare Advantage Base and Enhanced plans

Drug formulary from Express Scripts Medicare, current as of August 22, 2016. This list of covered drugs is for these university group Medicare insurance plans: Medicare Advantage Base Plan (plan #13759) and Medicare Advantage Enhanced Plan (plan #13760).

PDF
2017 Specialty drug list

2017 calendar year Specialty Drug List from Accredo, an Express Scripts Company, regarding maintenance medications for active employees with the Custom Network Plan, Health Savings Plan, or PPO Plan. This list also covers retirees with the Healthy Savings Plan or Retiree Health PPO Plan, with Rx.

PDF
Custom Network Plan: Columbia Coverage Map

Nine counties in which an employee must live and/or work to be eligible for the Custom Network Plan: Columbia.

PDF
Custom Network Plan: St. Louis Coverage Map

Twenty-four counties in which an employee must live and/or work to be eligible for the Custom Network Plan: St. Louis.

PDF
Health4Me smartphone app

This PDF shows you how to easily access your health care information and tools to help estimate costs, manage claims, and find providers with the Health4Me smartphone app from UHC.

PDF
myNurseline from UHC

Use this PDF as a guide to myNurseline, which helps you make smart health care decisions with immediate telephone and online access to experienced registered nurses.

PDF
Rally from UHC

This PDF serves as guide to Rally, an online experience that makes it easier for you to eat better, move more, and complete activities that help improve your health.

PDF
Registering on myUHC.com

Use this PDF for step by step instructions on how to register at myUHC.com where you will find the answers to your health and benefits questions and the information you need in one easy-to-use, convenient location online.

PDF
UHC Health Discount Program

Learn about this program that helps you and your family save typically 10 to 25 percent on many health and wellness purchases not included in your standard health benefit plan.

PDF
UHC myHealthcare Cost Estimator

Quickly and easily estimate your health care costs with this guide from UHC.

PDF
UnitedHealthcare Healthy Pregnancy Owner’s Manual

The Healthy Pregnancy Owner's Manual, from UM System medical insurance plan administrator UnitedHealthcare, contains information on all things baby-related, from taking care of a new baby, to outlining specific pregnancy programs offered through the medical insurance plan. (By visiting this link, you will exit the UM System website.)

Other
Where should I go for care?

Use this gudie from UHC to help you choose the right care center.

PDF
Creditable coverage notice for university-sponsored Medicare Advantage Plans with Rx coverage

The University of Missouri System has determined that the prescription drug coverage offered in conjunction with the University-sponsored Medicare Advantage (Base or Enhanced) Plans are, on average for all plan participants, expected to pay out as much as the standard Medicare Part D prescription drug coverage will pay and is therefore considered Creditable Coverage. Because your existing coverage is Creditable Coverage, you can keep this coverage and not pay a higher premium (a penalty) if you later decide to join a Medicare drug plan.

PDF
Medical and Dental Benefits Plans notice of privacy practices

This notice of privacy practices describes how health information about employees may be used and disclosed and how individuals can access to this information.

PDF
Non-creditable coverage notice for university-sponsored Medicare Advantage Plans with no Rx

The University of Missouri System has determined that the prescription drug coverage offered by the University-sponsored Medicare Advantage (Base or Enhanced) Plans–no Rx is, on average, NOT expected to pay out as much as the standard Medicare Part D prescription drug coverage will pay and is considered Non-Creditable Coverage. This is important because, most likely, you will get more help with your drug costs if you join a Medicare drug plan. This also is important because it may mean that you may pay a higher premium (a penalty) if you do not join a Medicare drug plan when you first become eligible.

PDF
M4A Medicare presentation

Missouri Association of Area Agencies on Aging provides this presentation on Medicare.

PDF
2017 Benefit Plans for retirees/dependent - Medicare Advantage Base and Enhanced plans

Watch this online seminar to learn about the university-sponsored, group Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan, available to Medicare-eligible retirees and dependents for the 2017 calendar year. This seminar was produced and distributed by UnitedHealthcare, who is delivering the university-sponsored Medicare Advantage group plans.

Video
Custom Network Plan summary of benefits and coverage (SBC) for calendar year 2017

Summary of benefits and coverage (SBC) document for the Custom Network Plan for 2017.

PDF
Custom Network Plan summary of benefits and coverage (SBC) for calendar year 2018

Summary of benefits and coverage (SBC) document for the Custom Network Plan for 2018.

PDF
Healthy Savings Plan summary of benefits and coverage (SBC) for calendar year 2017

Summary of benefits and coverage (SBC) document for active employees' Healthy Savings Plan for 2017.

PDF
Healthy Savings Plan summary of benefits and coverage (SBC) for calendar year 2018

Summary of benefits and coverage (SBC) document for the Healthy Savings Plan for 2018.

PDF
Medicare Advantage Base & Enhanced plans summary of benefits and coverage (SBC) for 2017

The 2017 summary of benefits and coverage (SBC) for the university-sponsored Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan are part of a broader document, titled What You Need to Know About Your Medicare Advantage Plan: 2017 Plan Guide. SBC-related information for the Medicare Advantage Base Plan (Plan #13759) is found on pp. 6-7 and 17-28. SBC-related information for the Medicare Advantage Enhanced Plan (Plan #13760) is found on pp. 8-9 and 29-40.

PDF
PPO Plan summary of benefits and coverage (SBC) for calendar year 2017

Summary of benefits and coverage document (SBC) for the PPO Plan for MU, MUHC, UMSL and UM System central administration for 2017.

PDF
PPO Plan-MU, UMSL, or UMSYS summary of benefits and coverage (SBC) for calendar year 2018

For employees at MU, MU Health, MU Extension, UMSL or the UM System central administration: Summary of benefits and coverage document (SBC) for the PPO Plan for 2018. Employees at UMKC or Missouri S&T should see the "PPO Plan-UMKC or Missouri S&T SBC."

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