Total Rewards - Forms and Guides

An overview of plan offerings and the insurance benefits enrollment process.

Retiree benefits enrollment/change form to be used to change insurance elections.

Note: This retiree benefit change form is also available in a combo pack of forms.

This form is necessary for enrolling in a health savings account (HSA) for this first time, or to make a change to an existing HSA. It applies to calendar year 2021.

Summary of benefits and coverage (SBC) document for active employees' Healthy Savings Plan is available on the all Summary of Benefits and Coverage (SBC) documents webpage.

Summary of benefits and coverage (SBC) document for the Custom Network Plan is available on the all Summary of Benefits and Coverage (SBC) documents webpage.

Summary of benefits and coverage (SBC) document for the PPO Plan is available on the all Summary of Benefits and Coverage (SBC) documents webpage.

Summary of benefits and coverage (SBC) document for the Retiree Health PPO Plan is available on the all Summary of Benefits and Coverage (SBC) documents webpage.

Summary plan description for the Defined Contribution Plan which includes provisions of the Employee Retirement Investment Plan (for employees hired or rehired after 10/1/19) is available on the SPDs webpage.

Summary of benefits and coverage (SBC) document for the PPO Plan with Tiered Feature is available on the all Summary of Benefits and Coverage (SBC) documents webpage.

Beginning in 2018, EyeMed is the administrator of the University of Missouri Vision Insurance Plan. Even if you aren’t enrolled in the insurance plan for 2018, you can take advantage of the EyeMed Insight Plan D discount program. This discount option is only available to employees and their family if no one in the family is enrolled in the full service vision plan.

A guide for accessing the EyeMed Members App with a few simple steps.

A guide detailing how to register online at EyeMed.com.

An overview of EyeMed vision coverage for the 2018 plan year.

Form to designate irrevocable employee contributions to the university’s 403(b) irrevocable retirement plan.

Summary plan description for the Retiree Health PPO Plan is available on the SPDs webpage.

Summary plan description for the Retiree Healthy Savings Plan is available on the SPDs webpage.

Summary plan description of the Flexible Benefit plan is available on the SPDs webpage.

Summary plan description overview of long-term disability benefits for UM System is available on the SPDs webpage.

Summary plan description for the university PPO Plan is available on the SPDs webpage.

Summary plan description for the university Healthy Savings Plan is available on the SPDs webpage.

Summary plan description for the university Custom Network Plan is available on the SPD webpage.

Summary plan description for the Hybrid Plan which includes provisions of the Retirement, Disability, and Death Benefit Plan (level two) and the Employee Retirement Investment Plan. Available on the SPDs webpage.

Summary plan description for the Defined Benefit (DB) Plan with includes provisions of the Retirement, Disability, and Death Benefit Plan (level one). Available on the SPDs webpage.

Summary Plan Description for Basic Life insurance for employees is available on the SPDs webpage

Summary plan description of the Dependent Life Insurance plan is available on the SPDs webpage.

Results of the 2017 Annual Enrollment process for active employees, conducted from October 17 to October 28, 2016.

Summary plan descriptions for the voluntary retirement plans: 403(b), 457(b), and 401(a) Plans at the University of Missouri System. Available on the SPDs webpage.

Summary plan description overview of the Vision Benefit Plan at the University of Missouri System is available on the SPDs webpage.

Summary plan description of the Dental Plan is available on the SPDs webpage.

Summary plan description for the University of Missouri System Accidental Death and Dismemberment insurance plan is available on the SPDs webpage.

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.)

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.

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 documentprovides both Summary Plan Description (SPD) and Summary of Benefits and Coverage (SBC) information for the two Medicare Advantage plans.

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

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.

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

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 UnitedHealthcare smartphone app from UHC.

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.

Results of the 2016 Annual Enrollment process for active employees, conducted from October 19 to October 30, 2015.

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

If your office would like to learn more about a wellness topic, use our form to request a presentation.

Another job evaluation tool that is designed to collect detailed information about the duties and responsibilities of the job as it currently exists from the job incumbent’s point of view. The collected job data will be used to help develop or revise job descriptions and evaluate the job for appropriate classification.

For use with the full Position Classification Questionnaire (PCQ) when job is in the Research job family.

For use with the full Position Classification Questionnaire (PCQ) when job is in the IT job family.

The university complies with the provisions of the FLSA applicable to public employers and educational institutions. In an effort to assure compliance with the FLSA, the university has established a number of policies as part of the UM System HR Manual, including HR-202: FLSA Status. Related policies include:

• HR-106: Reporting Hours Worked
• HR-211: Overtime
• HR-215: Compensatory Time

Additional information is available on the FLSA webpage.

This video explains the difference between a Healthy Savings Account and a Flexible Spending Account. Both accounts are available to pay for healthcare expenses throughout the year, but which account you can use depends on what type of insurance plan you have. (2:49)

This video explains the financial differences between paying your monthly premiums before taxes are deducted from your paycheck or after. (2:47)

This video explains what people data is in terms of a concept and a team of experts. It also explains how the UM System is using big data to realize the greatest potential of its greatest asset--its people. (1:47)

In this version of yoga #2, the camera follows Jenny more closely as she does the chair modification of each pose while Dr. Lynn Rossy, former Health Psychologist for Healthy for Life guides you through the practice of mindful yoga. Mindful hatha yoga consists of gentle stretching and strengthening exercises, done slowly, with moment-to-moment awareness of breathing and of the sensations that arise as you put your body into various postures. (36:32)

In this second session, Dr. Lynn Rossy, former Health Psychologist for Healthy for Life guides you through the practice of mindful yoga. Mindful hatha yoga consists of gentle stretching and strengthening exercises, done slowly, with moment-to-moment awareness of breathing and of the sensations that arise as you put your body into various postures. (36:32)

In this version the camera follows Jenny more closely as she does the chair modification of each pose while Dr. Lynn Rossy,  former Health Psychologist for Healthy for Life guides you through the practice of mindful yoga. Mindful hatha yoga consists of gentle stretching and strengthening exercises, done slowly, with moment-to-moment awareness of breathing and of the sensations that arise as you put your body into various postures. (37:14)

Dr. Lynn Rossy, former Health Psychologist for Healthy for Life guides you through the practice of mindful yoga. Mindful hatha yoga consists of gentle stretching and strengthening exercises, done slowly, with moment-to-moment awareness of breathing and of the sensations that arise as you put your body into various postures. (37:14)

Join Dr. Lynn Rossy in this Eat for Life yoga session. Rossy covers the basics of various types of postures, so you can lay down the groundwork for any future yoga you decide to do. (19:46)

This video gives an overview of what it means to be part of the University of Missouri's culture of health. Interviews with employees offer great insight into the importance of healthy workplace habits and work-life balance. (4:39)

Listen to this short one-minute video of Dr. Rossy's BASICS of Mindful Eating. Produced by HOPE Health (www.hopehealth.com), a specialty publisher focused on producing easy-to-understand, interesting, and actionable health, wellness, and benefit media for employers and employees (1:02).

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

Express Scripts Medicare Part D prescription claims form.

Active employee Beneficiary Designation Form to be used for beneficiary designations for Basic Life, Supplemental Life, Accidental Death and Dismemberment, and pre-retirement death benefit under the DB Plan and Hybrid Plan.

Use this form to waive long term disability coverage.

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 in this same file (following the benefit change form).

Form for retirees to designate beneficiaries for basic life, supplemental life, and accidental death and dismemberment plans.

Note: This retiree beneficiary designation form is also available in a combo pack of forms.

The merit handbook video for employees/managers in the immediate UM System offices helps explain the link between pay and merit. This handbook also details recommend annual merit increases based on performance and where your employees fall within their ranges.

The merit handbook for employees/managers in the immediate UM System offices helps explain the link between pay and merit. This handbook also details recommend annual merit increases based on performance and where your employees fall within their ranges.

Additional information associated with the topic “women’s health” can be found on the women’s preventive health care webpage.

No forms or guides are associated with the topic “Total Rewards Task Force.” For more information, visit the Total Rewards Task Force page.  

No forms or guides are associated with the topic “Total Rewards Advisory Committee." Learn more about TRAC at the Total Rewards Advisory Committee page.

No forms or guides are associated with the topic “strategic initiatives.” However, if you are interested in learning more about the strategic initiatives that inform the Total Rewards Department’s current and future plans, you can find more information on the strategic initiatives page.  

No forms or guides are associated with the topic “service awards.” However, if you are a supervisor honoring an employees’ years of service, or an employee who has recently received a service award, you can find more information on the service awards page.  You may also read several FAQs related to service awards.

No forms or guides are associated with the topic “rehire of retirees.” However, more information on the rehire requirements for retired or vested individuals who are less than age 62 can be found on the retiree rehire requirements page. Also available are many FAQs about the rehire of retirees.  

No forms or guides are associated with the topic “Patient Protection and Affordable Care Act.” However, more information on PPACA is available on the Affordable Care Act page.  You may also read several FAQs related to the PPACA.

No forms or guides are associated with the topic “military leave”. However, you will find more information on options for university benefits available during a military leave of absence on the military page.  

You will find information about coverage, on-campus flu shot clinics for employees, necessary forms, and wellness incentive points on the flu shots and health screenings page.

No forms or guides are associated with the topic “diabetes.” However, the coverage for diabetes page offers information on obtaining diabetic supplies under your medical insurance plan or your prescription drug plan.

Employees who have terminated from the University of Missouri and have not taken their vested benefit under the DB Plan or Hybrid Plan, may designate beneficiaries for their benefit in the event of their passing prior to the commencement of benefits.

Some COBRA information in outlined in the Benefits Guide for COBRA Participants, however, most information is provided on the COBRA Participant Information webpage.

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

Summary plan description for parties involved in a marriage dissolution to gain a better understanding of how pension benefits under the Retirement, Disability, and Death Plan may be divided in a divorce proceeding. Available on the SPDs webpage.

Results of the 2015 Annual Enrollment process for active employees, conducted from October 20 to October 31, 2014.

Data supplement for the performance report about the results of the 2015 Annual Enrollment process.

Claim form for the university Dental Plan.

Informational image explaining aspects of the university tuition assistance discount for employees.

Claim form for flexible spending accounts (FSA).

If you are absent or expect to be absent from work in excess of 149 calendar days due to sickness or accidental injury, you must report your absence. This guide from MetLife explains the process of reporting long-term absences.

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

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

Express Scripts prescription claims form.

Express Scripts prescription drug mail-in order form.

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

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

Complete the Educational Assistance and Tuition Reduction Form, available in the HR Request Portal (you will need to log in with your University ID and password).

If you are seeking tuition assistance for a spouse/dependent for the first time, please be aware that proof of relationship will be required. On the forms and guides list for educational/tuition assistance, you may access the proof of relationship requirements for children, spouses, and Sponsored Adult Dependents, as well as the Sponsored Adult Dependent form should you need it.

Also you may visit the tuition assistance webpage for an overview of the program. Or contact your Campus Benefits Representative or the HR Service Center to find out if proof of relationship is already on file with the Office of Human Resources.

Form for reimbursing qualified vision expenses incurred at out-of-network providers.

Worksheet for budgeting your monthly budget and comparing them to actual expenditures

Questionnaire to help you begin to explore whether the feelings, thoughts, or behaviors you may be experiencing could be depression

Presentation to review the signs and symptoms of distress, identify strategies to help, and become familiar with resources

What is grief? This document provides an overview and guidelines for resolving it.

Template for calculating non-essential expenditures to help improve your financial health

What is stress? This document provides an overview.

Guidelines and considerations for making salary adjustments

Guidelines and considerations for making salary adjustments

Guidelines and considerations for making salary adjustments

Guidelines and considerations for making salary adjustments

Guidelines and considerations for salary adjustments

Job title structure and salary ranges for the Division of Information Technology

Template for writing a departmental job description

Template for writing a global job description

The University of Missouri has prepared this Leadership Administration Guidelines for use by the Human Resources Department and supervisors/managers (leaders) who have responsibility for people – that is, those who have a part in setting and administering the pay of employees. Its purpose is to provide a detailed source of information that will help the organization manage non-academic and non-union staff compen- sation in a consistent manner.

Set of slides to explain to employees how the Global Grading System was put in place for administrative, service, and support staff compensation.

Set of slides to explain to leaders how the Global Grading System was put in place for administrative, service, and support staff compensation.

Use this form to classify a new position or reclass an incumbent or vacant position.

Designate beneficiaries for retirement benefits under the Retirement, Disability and Death (RDD) Benefit Plan’s Guaranteed Period Option.

​Division of benefits order template to specify division of university pension benefits upon divorce.

Form to designate irrevocable employee contributions to the university’s 401(a) Supplemental Retirement Plan.

This document provides a high-level overview of The Hybrid Plan, a mixed pension and matching plan. The Hybrid Plan has two components: (1) the defined benefit component and (2) the defined contribution component. This document summarizes both.

Retirees may use this form to change their mailing address with the University of Missouri System Office of Human Resources.

Tutorial for finding the UM Pension Benefits Portal in myHR and running the university’s retirement calculator for pension benefits earned under the DB Plan or Hybrid Plan.

This direct deposit form is located on the HR Forms webpage. Locate it in the list by the name (Direct Deposit) or the form number (32B).

Form W-4P is for U.S. citizens, resident aliens, or their estates who are recipients of pensions, annuities (including commercial annuities), and certain other deferred compensation. Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s).

NOTE: You will be redirected to the IRS website to access this form.

If you reside in Illinois, you must complete an Illinois W-4 form so the University can withhold the correct amount of Illinois Income Tax from your pay.

Note: You will be redirected to the Illinois Revenue website to access this form.

If you are a retiree or beneficiary receiving pension payments from the DB Plan or Hybrid Plan and residing in Missouri, complete the MO W-4P form to voluntarily elect withholding of Missouri State Income Tax from pension or annuity income only.

NOTE: You will be redirected to the Missouri Department of Revenue website to access this form.

Form for formally requesting the university to not withhold Missouri income taxes from pay due to an employee performing services for the university outside of Missouri, or a retiree or beneficiary residing outside of Missouri.

Use this form to officially announce your plans to retire from the university under the DB Plan or Hybrid Plan. Submit this form to your HR Generalist in time to allow the information to reach the UM System Office of Human Resources at least 60 days prior to your retirement date.

This guide is available to employees who have announced their intention to retire under the defined benefit components of the DB Plan or Hybrid Plan, explaining next steps.

Provides a high-level overview of the Voluntary Retirement Plan options for both benefit-eligible and non-benefit eligible faculty and staff.

Healthy for Life faculty or staff members, consultants, volunteers or students at the University of Missouri System may learn of, or have access to, confidential information. This agreement clarifies what confidential information is and what the corresponding responsibilities are.

Participants in the Healthy for Life weight-loss and physical activity classes must sign this consent to participate and waiver of liability form.

Letter to instructors of Healthy for Life classes requesting session information.

This is an optional form that may be used at the manager’s discretion for setting up a flex place arrangement for an employee.

Want to exercise during the day, but aren’t sure how to return to work post-workout? This list of tips may help you find a solution to stay fresh for the rest of the business day.

Measured walking map around Arts and Administration Building at University of Missouri St. Louis.

Measured walking map around the Missouri University of Science and Technology campus perimeter.

Measured walking maps around Castleman Loops at Missouri University of Science and Technology.

Measured walking map around Curtis Laws Wilson Library Loops at Missouri University of Science and Technology.

First measured walking map around Discovery Ridge at University of Missouri-Columbia.

Second measured walking map around Discovery Ridge at University of Missouri-Columbia.

Measured walking map around Emerson Loop at Missouri University of Science and Technology.

Measured walking map around Francis Quadrangle at University of Missouri- Columbia.

Measured walking map around Havener Center at Missouri University of Science and Technology.

Measured walking map around Hospital Hill at the University of Missouri Kansas City.

Measured walking map around Hospital and Student Recreation Center at University of Missouri-Columbia.

Measured walking map around Hospital and Stankowski Field at the University of Missouri- Columbia.

Measured walking map around hospital and Student Center at University of Missouri- Columbia.

Measured walking map around the J.C. Penney Building at University of Missouri St. Louis.

Measured walking map around Jessie Hall Tree Trail at University of Missouri-Columbia.

Measured walking map around the Lowry Mall Tree Trail at the University of Missouri- Columbia.

Measured walking map around Marillac Hall at University of Missouri St. Louis.

Measured walking map around Memorial Union Tree Trail at the University of Missouri-Columbia.

Measured walking map around the Millennium Student Center at the University of Missouri St. Louis.

Measured walking map around Mizzou North at the University of Missouri- Columbia.

Measured walking maps around Norwood Loop at the Missouri University of Science and Technology.

Measured walking map around the Nursing Administration Building at the University of Missouri St. Louis

Additional measured trails in Columbia that do not currently have a corresponding walking map.

Measured walking map around Peace Park in Columbia.

Measured walking map around Printing and Publications Facility at Columbia

Measured walking map around Quarterdeck at the University of Missouri- Columbia

Measured walking map around Sandborn Field at University of Missouri-Columbia.

Measured walking map around the Social Science Business Building at UMSL.

Measured walking map around Stadler Hall at UMSL.

Measured walking map of the The Halls at UMSL.

Measured walking map around Thomas Jefferson Library at UMSL.

Measured walking map of Touhill Performing Arts at UMSL.

Measured walking map for the Volker Campus at UMKC.

Measured walking map for the Volker Campus at UMKC.

Measured walking map around Barnes Library at UMSL.

Measured walking map around Women’s and Children’s Hospital in Columbia.

Measured walking map around Woods Hall at UMSL.

June 2014 letter from Total Rewards’ Associate Vice President Kelley Stuck to retirees regarding the Total Rewards Task Force recommendation to examine the retiree medical offerings from the university.

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

Those participating in the Step Program can use this handy spreadsheet to keep track of your steps, and has formulas to easily offer up your averages and totals.

This notice describes how Wellness program health information about UM System employees may be used and disclosed and how employees can access this information.

This document provides a high-level overview of the Defined Benefit (DB) Plan, one of the core retirement plan options.

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

A tip sheet from the Employee Assistance Program containing principles and techniques to promoting effective communication and being an effective communicator.

Financial Health

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

Providing Evidence of Insurability in 2020

If you elect life insurance coverage for 2020 that requires evidence of insurability, Unum will email your University email account with a link to your personalized evidence of insurability application in December 2019.

The email will come from TheUnumClientServiceCenter@unum.com and the subject line will read: “Your Recent Insurance Election – Action requested”. If approved, coverage will become effective January 1, 2020, or upon approval by Unum if after January 1.

If you have questions about your personalized evidence of insurability application once it is received, please contact Unum customer service at 866-220-8460 from 7:00 a.m. until 5:00 p.m. CST.

This form is for individuals who are currently enrolled in an HSA through the Healthy Savings Plan, a qualified high-deductible plan. Completion of this form will cancel your enrollment.

Designate beneficiaries for the university’s supplemental life insurance plan.

Use this form to cancel your supplemental life insurance plan

Form used to exercise the option to sell shares of Fidelity Investments Asset Manager 50%, to which an individual may be entitled under the terms and conditions of the University of Missouri Faculty Performance Shares Plan.