Action | Action Date | Preparer Initials |
|---|---|---|
| Benefits – Refer to EDB Manual B12.0 | ||
| Termination of Employment Checklist | ||
| Health and Welfare Plans | ||
| COBRA - Notification from CONEXIS 24 weeks from separation function in EDB (Automatically generated when separation function is performed) | ||
| COBRA Premium Rates and Insurance carrier address information | ||
| COBRA Notice | ||
| HealthCare/DepCare Reimbursement Account COBRA continuation (for HCRA only) | ||
| AD&D Conversion Provide the conversion application and direct employee to AIG Benefit Solutions at 800-551-0824 | ||
| Basic/Supplemental Life Conversion Print out Conversion Form in Related Information Must complete and sign form before handing it to employee | ||
| Supplemental Life/Expanded Dependent Life Portability Direct employees to Welfare Plans in Related Information | ||
| Legal Plan Conversion Direct employee to ARAG Plan in Related Information | ||
| Retirement Plans | ||
| UC Retirement Savings Program (DCP, 403(b), 457(b) plan) for distributions and/or future inquiries direct employee to the Fidelity Retirement Services website in Related Information. | ||
| CAP – Distribution Request UBEN142 CAP (R4/14) Direct employee to automated request system on UCnet (At Your Service) following a separation of 30 days or more | ||
| Refund of Accumulations UCRP Following a break in service of 30 days or more, direct employee to UCnet (At Your Service). See Related Information. | ||
| UCRP Pension Benefits Estimates Direct employee to UCnet (At Your Service). See Related Information. |
Campus Human Resources, Benefits Services
Phone: (310) 794-0830 | Fax: (310) 794-0835
