91دم½¶¶جتسئµ

Skip to main content

Total Rewards - Forms and Guides

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

| PDF

Flyer overviewing university benefits available for staff

| PDF

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

| PDF

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

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

| PDF

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

Summary plan description overview of the Vision Benefit Plan at the 91دم½¶¶جتسئµ 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 91دم½¶¶جتسئµ System Accidental Death and Dismemberment insurance plan is available on the SPDs webpage.

| PDF

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

| PDF

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

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

| PDF

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.

| PDF

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

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

| PDF

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

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)

| Other

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

| PDF

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.

| PDF

Use this form to waive long term disability coverage.

| Other

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

| Other

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.

| Other

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.  

| Other

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.

| Other

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

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

| PDF

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

| PDF

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

| PDF

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

| PDF

Claim form for the university Dental Plan.

| PDF

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

| PDF

Claim form for flexible spending accounts (FSA).

| PDF

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.

| PDF

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

Express Scripts prescription claims form.

| PDF

Express Scripts prescription drug mail-in order form.

| PDF

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

| PDF

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

| Other

Complete the , 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.

| PDF

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

| Word

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

| PDF

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

| PDF

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

| Word

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

| PDF

What is stress? This document provides an overview.

| PDF

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

| PDF

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

| PDF

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

| Powerpoint

Financial Health

| PDF

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

| PDF

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.

| PDF

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

| PDF

Use this form to cancel your supplemental life insurance plan