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BENEFITS MATERIALS LIST |
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Order Items From The Campus Benefits Office which are labeled "BEN" by Faxing Requests to x40835. |
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Order Items From the Fulfillment House
which are labeled "FH" by going to KP UC website:
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Other Items are Ordered by Calling The Carriers Directly At The Indicated Phone Numbers. |
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BOOKLETS |
Rev. Date |
Part Number |
LOCATION |
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BENCOM.FONE BROCHURE |
3/99 |
4003 |
FH |
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UCLA BENEFITS HIGHLIGHTS BROCHURE |
10/98 |
N/A |
BEN |
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YOUR GROUP INSURANCE PLANS |
1999 |
2001 |
FH |
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1999 Medial plan Spreadsheet - No. & So. California |
1999 |
2110 |
FH |
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CALIFORNIA CONSUMER HEALTH SCOPE |
1998 |
2605 |
FH |
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1998 Enrollment Worksheet - Career/Limited Career (IVR -1) |
6/98 |
2003 |
FH |
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1999 Enrollment Worksheet - Core (IVR -2) |
6/98 |
2004 |
FH |
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CHECKLISTS: |
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Disability |
8/98 |
3005 |
FH |
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Disaster Preparedness |
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3011 |
FH |
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Family and Medical Leave (FMLA) |
8/98 |
3010 |
FH |
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Family Status Changes |
7/98 |
3009 |
FH |
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Furlough |
2/99 |
3008 |
FH |
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Indefinite Layoff |
4/99 |
3002 |
FH |
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Leave Without Pay |
2/99 |
3003 |
FH |
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Maternity |
8/98 |
3004 |
FH |
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Military Leave |
2/99 |
3001 |
FH |
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Paid Leave |
4/99 |
3013 |
FH |
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Sabbatical |
4/99 |
3014 |
FH |
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Temporary Layoff |
2/99 |
3006 |
FH |
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Termination of Employment |
4/99 |
3007 |
FH |
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HEALTH and WELFARE BOOKLETS: |
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MEDICAL: |
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Core Major Medical Health Plan |
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N/A |
(800)632-0524 |
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Core - Medical Plan Spreadsheet |
1999 |
2102 |
FH |
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HealthNet Plan |
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N/A |
(800)522-0088 |
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Kaiser Health Plan |
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N/A |
(800)464-4000 |
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PacifiCare Health Plan |
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N/A |
(800)624-8822 |
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Prudential High Option Health Plan |
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N/A |
(800)632-0524 |
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UC Care Health Plan |
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N/A |
(800)313-3804 |
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DENTAL BOOKLETS: |
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Delta Dental Services |
2/98 |
N/A |
(888)335-8227 |
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PMI Dental Care |
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N/A |
(800)422-4234 |
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1999 Dental Spreadsheet |
9/98 |
2210 |
FH |
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VISION SERVICE PLAN |
1/97 |
N/A |
(800)622-7444 |
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DISABILITY (Liberty Mutual) |
1/97 |
N/A |
BEN |
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LEGAL Brochure |
1998 |
N/A |
BEN |
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LEGAL Directory of Participating Attorney's |
8/98 |
N/A |
BEN |
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LIFE INSURANCE (Prudential Life Insurance) |
1/97 |
N/A |
BEN |
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Dependent Care (DepCare) - Summary Plan Description |
1/99 |
2400 |
FH |
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TIP-Tax Savings on Insurance Premiums Summary Plan Description |
1/99 |
2402 |
FH |
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RETIREMENT & TAX - DEFERRED SAVINGS |
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DCP (Safe Harbor) Questions and Answers (pamphlet) |
9/98 |
N/A |
BEN |
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DCP Summary Plan Description (Pre-tax and After-Tax) |
5/98 |
1100 |
FH |
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UCRP (with Social Security) |
7/97 |
1001 |
FH |
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UCRP (without Social Security) |
11/97 |
1002 |
FH |
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UCRP (Safety Benefits for Police and Fire Employees) |
5/98 |
N/A |
BEN |
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UCRP (Tier Two -- Summary Plan Description) |
1/99 |
N/A |
BEN |
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Retirement Handbook |
8/98 |
1400 |
BEN |
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Election Kit |
8/98 |
1410 |
BEN |
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Investing for Tomorrow's Retirement Today |
2/99 |
1600 |
FH |
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PERS (Designation of Beneficiary State Form 241) |
8/94 |
N/A |
BEN |
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PERS (Retirement Booklet State Miscellaneous 2% at 60) |
1/95 |
N/A |
BEN |
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American Century/Benham Group Enrollment Kit |
1/97 |
N/A |
(800)472-3390 |
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Calvert Fund Enrollment Kit |
8/97 |
N/A |
BEN |
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Fidelity Enrollment Kit |
12/97 |
N/A |
(800)868-1023 |
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Tax - Deferred 403(b) Summary Plan Description |
2/98 |
1110 |
FH |
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Tax - Deferred 403(b) Loan Program |
5/98 |
N/A |
BEN |
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Today's Decision, Tomorrow's Security |
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N/A |
BEN |
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U.S. Savings Bonds Payroll Savings Plan |
10/96 |
N/A |
BEN |
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FORMS |
Rev. Date |
Part Number |
LOCATION |
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PERSONAL IDENTIFICATION NUMBER (PIN) AUTHORIZATION |
7/98 |
UPAY 874 |
FH |
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HEALTH AND WELFARE FORMS: |
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On-Line Enrollment, Change, Cancellation, Opt-Out |
7/98 |
UPAY 850 |
FH |
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COBRA Continuation Election |
8/98 |
UBEN 102 |
FH |
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Core Claim Forms |
2/96 |
N/A |
BEN |
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Prudential Health Insurance Claim Forms |
3/98 |
N/A |
BEN |
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UC Care Insurance Claim Forms |
3/98 |
N/A |
(800)313-3804 |
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Liberty Mutual Disability Statement of Health |
11/96 |
N/A |
BEN |
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Prudential Statement of Health (Life, UC Care, Pru High) |
3/98 |
N/A |
BEN |
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BENEFICIARY FORMS: |
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Designation of Beneficiary - UCRS |
8/97 |
UBEN 114 |
FH |
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Designation of Beneficiary, Life and AD&D Insurance |
5/99 |
UPAY 718 |
FH |
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RETIREMENT & TAX- DEFERRED FORMS: |
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UCRP Tax - Deferred 403(b) Salary Reduction Agreement |
7/98 |
UPAY 801 |
FH |
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UCRP After - Tax Contribution Plan (Payroll Deduction) |
7/97 |
U5637CA |
FH |
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DCP - Pretax Account Fund Designation |
7/98 |
UPAY 752 |
FH |
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DCP & 403(b) Transfer Request / UC-managed Funds |
7/98 |
U5637T |
FH |
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DCP & 403(b) Transfer Request / Fidelity Investments |
7/98 |
U5640T |
FH |
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DCP Transfer Request / Fidelity Investments |
7/98 |
U5641T |
FH |
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UCRP Buyback Request Booklet |
5/97 |
1009 |
FH |
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UCRS Distribution Kit |
12/98 |
UBEN 150 |
FH |
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UCRS Distribution Kit for Non-Exempt Student Employees |
5/97 |
UBEN 200 |
FH |
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DEPCARE: |
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DepCare Reimbursement Request |
1/99 |
UCRS 155 |
FH |
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DepCare/TIP Salary Reduction Agreement-Enroll, Change or Cancel |
7/93 |
UPAY 717 |
FH |
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UNIVERSITY CONTRIBUTION INDICATOR |
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(for Family and Medical Leave, Furlough and Temporary Layoff) |
11/97 |
UPAY822-4 |
BEN |
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U.S SAVINGS BONDS-- Series EE Payroll Deduction Authorization |
7/91 |
UPAY 694 |
FH |
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