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Human Resources - Employee Benefits

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2008 Publications

2008 Benefits & Erollment Guide for Employees

2008 Three-Tier Prescription Drug List Reference Guide (not yet available)

Benefacts

2008 Forms

Medical

Domestic Partnership Affidavit
Termination of Domestic Partnership
UHC Drug Mail Order Form

Life Insurance

2008 Life Insurance Plans - UnitedHealthcare Specialty Benefits

Group Life Insurance Policy
Group Life Insurance Policy (En Espanol) (not yet available)
Group Life Insurance Certificate of Coverage (not yet available)
Group Life Insurance Certificate of Coverage (En Espanol)

(not yet available)

Deferred Compensation

401(k) Plan Enrollment Guide
457 Plan Enrollment Guide

401(k) Retirement Savings Plan Beneficiary Designation Form
457 Deferred Compensation Plan Beneficiary Designation Form
457 PST Plan Beneficiary Designation Form

Beneficiary Designation

Employees' Retirement Fund (ERF) Designee Form
Active Employee Final Paycheck Beneficiary Designation Form

2008 PPO Plans - United Healthcare

80-20 PPO Plan - $300/$1000/$3000 Deductible
70-30 PPO Plan - $300/$1000/$3000 Deductible

2008 EPO Plan

EPO Summary Plan Description

2008 Voluntary Benefits - Marsh @ Work Solutions (see the Voluntary Benefits Program section of the 2008 Benefits & Enrollment Guide for a description of each of these voluntary benefits or contact Marsh at: 1-800-557-1046. For 2008, to enroll in Dental or Vision you must contact the Benefits Service Center at 1-888-866-7692.)

Dental Plans - Safeguard
Vision Plan - Spectera
Long-term Care Insurance - Metropolitan Life Group
Paycheck Protector - The Hartford

2008 Life Insurance Plans - Standard (see the life insurance section of the 2008 Benefits & Enrollment Guide for a description of this benefit)

Group Life Insurance Certificate of Coverage (not yet available)
Group Life Insurance Policy (not yet available)

2008 Flexible Spending Accounts - United Healthcare

United Healthcare Flexible Spending Account (EMSP and DCAP)
Reimbursement Claim Form
Over-the-Counter (OTC) Medical Care Items eligible and Ineligible for
Reimbursement under UnitedHealthcare Plans

2008 Legislative Notices

HIPAA Privacy Notice
HIPAA Plan Amendment

2008 Vendor Web Sites and Customer Service Numbers

	City of Dallas Benefits Service Center (Your first contact for Customer Service)	1-888-873-7692

	City of Dallas Employee Benefits Customer Service Request Form

	UnitedHealthcare	1-800-736-1634
	SEA - Employee Benefits Web Enrollment
	Safeguard Dental Plans
	Dental HMO	1-800-880-1800
	Dental Indemnity	1-800-962-9633
	Spectera Vision	1-800-638-3120
	Marsh@WorkSolutions-Voluntary Benefits	1-800-557-1046
	UnitedHealthcare Specialty Benefits	1-866-615-8727

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