Documents by Office

Title Published File(s) Page
Required Documentation for Eligible Dependents Chart Chart - Required Documentation for Eligible Dependents More Info on Required Documentation for Eligible Dependents Chart
Preventive Services for All Ages Family Wellness and Preventive Care More Info on Preventive Services for All Ages
UT Retirement Provider Advisor Listing UT Retirement Provider Advisor Listing (02/17/2025) More Info on UT Retirement Provider Advisor Listing
UTSaver DCP - 457(b) Plan Document UTSaver DCP - 457(b) Plan Document More Info on UTSaver DCP - 457(b) Plan Document
UTSaver TSA - 403(b) Plan Document UTSaver TSA - 403(b) Plan Document More Info on UTSaver TSA - 403(b) Plan Document
Optional Retirement Program (ORP) Plan Document Optional Retirement Program (ORP) Plan Document More Info on Optional Retirement Program (ORP) Plan Document
Group Term Life Certificate Group Term Life Certificate (effective 09/01/2024) More Info on Group Term Life Certificate
UT SELECT Where to Go for Care UT SELECT Where to Go for Care More Info on UT SELECT Where to Go for Care
Superior Vison Claim Form Superior Vison Claim Form More Info on Superior Vison Claim Form
UT CARE Medicare Welcome Letter UT CARE Medicare Welcome Letter More Info on UT CARE Medicare Welcome Letter
UT CARE Medicare Sample Enrollment Kit UT CARE Medicare Sample Enrollment Kit (effective January 1, 2024)
UT CARE Medicare Kit de Inscripción (en Español)
UT CARE Medicare Sample Enrollment Kit (effective January 1, 2025) 		More Info on UT CARE Medicare Sample Enrollment Kit
UT SELECT Benefits Summary Chart UT SELECT Benefits Summary Chart 2024-2025 More Info on UT SELECT Benefits Summary Chart
DeltaCare Benefits Guide 2024-2025 DeltaCare Benefits Guide More Info on DeltaCare Benefits Guide
UT FLEX Reimbursement Claim Form UT FLEX Claim Form More Info on UT FLEX Reimbursement Claim Form
Life and AD&D Brochure for Active Employees Life and AD&D Benefit Brochure for Active Employees More Info on Life and AD&D Brochure for Active Employees
Group Term Life Brochure for Retired Employees Group Term Life Brochure for Retired Employees More Info on Group Term Life Brochure for Retired Employees
UT FLEX Letter of Medical Necessity Form Letter of Medical Necessity More Info on UT FLEX Letter of Medical Necessity Form
UT Benefits Enrollment Guide for Retiring Employees NEW! 2024-2025 UT Benefits Enrollment Guide for Retiring Employees
2023-2024 UT Benefits Enrollment Guide for Retiring Employees 		More Info on UT Benefits Enrollment Guide for Retiring Employees
BCBSTX Annual Wellness Checklist BCBSTX Annual Wellness Checklist for UT Benefits Members More Info on BCBSTX Annual Wellness Checklist
J-Visa Summary of Benefits and Coverage NEW! 2024-2025 Summary of Benefits: J-Visa Plan
2023-2024 Summary of Benefits: J-Visa Plan
2023-2024 Summary of Benefits: J-Visa Plan (Spanish/Español) 		More Info on J-Visa Summary of Benefits and Coverage
Accidental Death & Dismemberment Certificate Accidental Death & Dismemberment Certificate (effective 09/01/2024)
Accidental Death & Dismemberment Certificate (expires 09/01/2024) 		More Info on Accidental Death & Dismemberment Certificate
Seasons of Life UT SELECT Seasons of Life Brochure
UT SELECT Seasons of Life Presentation 		More Info on Seasons of Life
Delta Dental Support for Chronic Conditions Delta Dental Support for Chronic Conditions with SmileWay More Info on Delta Dental Support for Chronic Conditions
Delta Dental Mouth and Body Connection Delta Dental: The vital connection between oral health and overall health More Info on Delta Dental Mouth and Body Connection
Delta Dental Go PPO Delta Dental Go PPO: 6 great reasons to stay in-network More Info on Delta Dental Go PPO
Delta Dental Savings with BrushSmart Delta Dental BrushSmart Savings More Info on Delta Dental Savings with BrushSmart
Delta Dental Grin E-Magazine Delta Dental Grin! E-Magazine More Info on Delta Dental Grin E-Magazine
The Importance of an Eye Exam Superior Vision: The Importance of an Eye Exam More Info on The Importance of an Eye Exam
Progyny Fertility Benefits Brochure & Member Guide Progyny Fertility Benefits Overview More Info on Progyny Fertility Benefits Brochure & Member Guide
Superior Vision: Laser Vision Correction (LASIK) Superior Vision: Laser Vision Correction (LASIK) More Info on Superior Vision: Laser Vision Correction (LASIK)
Living Well Platform How to Guide Living Well Platform How to Guide More Info on Living Well Platform How to Guide
UT SELECT MDLIVE Overview UT SELECT MDLIVE Brochure 2024 More Info on UT SELECT MDLIVE Overview
Employee Enrollment Form - UT Benefits 2024-2025 Employee Enrollment Form for UT Benefits (PDF)
2024-2025 Employee Enrollment Form for UT Benefits (fillable PDF)
2023-2024 Employee Enrollment Form for UT Benefits (PDF)
2023-2024 Employee Enrollment Form for UT Benefits (fillable PDF) 		More Info on Employee Enrollment Form - UT Benefits
Superior Vision Online Retailers NEW! Introducing Warby Parker through MetLife® Vision
Superior Vision Online Contacts and Lenses Retailers 		More Info on Superior Vision Online Retailers
How to Log into the Mobile App - My UT Benefits Logging Into the Benefitplace App to Access My UT Benefits More Info on How to Log into the Mobile App - My UT Benefits
UT Benefits Billing Direct Payment/Debit Authorization Agreement Direct Payment/Debit Authorization Agreement More Info on UT Benefits Billing Direct Payment/Debit Authorization Agreement
Preventive Services for Adults Adult Wellness Guidelines More Info on Preventive Services for Adults
Preventive Services for Children Wellness Guidelines for Children More Info on Preventive Services for Children
Perinatal Wellness Guidelines Recommendations for a Healthy Pregnancy More Info on Perinatal Wellness Guidelines
Affordable Care Act - Marketplace Notices Stephen F Austin State University ACA Notice
UT Arlington ACA Notice
UT Austin ACA Notice
UT Dallas ACA Notice
UT El Paso ACA Notice
UT Health Houston ACA Notice
UT Health San Antonio ACA Notice
UT Health Tyler ACA Notice
UT Medical Branch Galveston ACA Notice
UT MD Anderson Cancer Center ACA Notice
UT Permian Basin ACA Notice
UT Rio Grande Valley ACA Notice
UT San Antonio ACA Notice
UT Southwestern Medical Center ACA Notice
UT System Administration ACA Notice
UT Tyler ACA Notice 		More Info on Affordable Care Act - Marketplace Notices
Vendor Services Vendor Services for Retirement Participants More Info on Vendor Services
TRS Annuity Deduction Form TRS Annuity Deduction Form More Info on TRS Annuity Deduction Form
Enrolling as a New Hire During Annual Enrollment Enrolling as a New Hire During Annual Enrollment More Info on Enrolling as a New Hire During Annual Enrollment
Superior Vision Standard Benefits Guide Superior Vision Standard Plan Certificate More Info on Superior Vision Standard Benefits Guide
Short-Term Disability Certificate Short Term Disability Certificate 2023-2024 More Info on Short-Term Disability Certificate
Long-Term Disability Certificate 2023-2024 Long Term Disability Certificate More Info on Long-Term Disability Certificate
Superior Vision Plus Benefits Guide Superior Vision Plus Plan Certificate More Info on Superior Vision Plus Benefits Guide
Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program Tobacco Cessation Program Physician Statement More Info on Physician Statement Concerning Tobacco Usage and Fitness to Participate in a Tobacco Cessation Program
Tobacco Premium Program Declaration Form Tobacco Premium Program Declaration Form More Info on Tobacco Premium Program Declaration Form
Insurance FAQs for Stephen F. Austin State University Insurance FAQs for SFA University Members More Info on Insurance FAQs for Stephen F. Austin State University
Benefits Coverage Mapping for SFA Employees & Retirees Benefits Coverage Mapping for SFA Employees
Benefits Coverage Mapping for SFA Retirees 		More Info on Benefits Coverage Mapping for SFA Employees & Retirees
Superior Vision: Getting Started with the Online Member Portal Superior Vision Online Member Portal More Info on Superior Vision: Getting Started with the Online Member Portal
UT SELECT Health Advocate Solutions FAQs UT SELECT Health Advocate Solutions FAQs More Info on UT SELECT Health Advocate Solutions FAQs
UT SELECT Health Advocate Solutions Infographic UT SELECT Health Advocate Solutions Infographic More Info on UT SELECT Health Advocate Solutions Infographic
Prescription Drug Annual Enrollment Overviews UT SELECT Prescription Drug Overview 2023-2024 More Info on Prescription Drug Annual Enrollment Overviews
Getting Started with Home Delivery from Express Scripts Pharmacy Getting Started with Home Delivery from Express Scripts Pharmacy More Info on Getting Started with Home Delivery from Express Scripts Pharmacy
Express Scripts: Manage Your Prescription Plan Express Scripts: Manage Your Prescription Plan More Info on Express Scripts: Manage Your Prescription Plan
Express Scripts: How to Register Online Express Scripts: How to Register Online More Info on Express Scripts: How to Register Online
UT FLEX How to Use Your Flexible Spending Account UT FLEX How to Use Your Flexible Spending Account More Info on UT FLEX How to Use Your Flexible Spending Account
SFA Benefits Comparison SFA Benefits Comparison for Employees and Retirees More Info on SFA Benefits Comparison
Express Scripts Print and Digital ID Cards Express Scripts Print and Digital ID Cards More Info on Express Scripts Print and Digital ID Cards
UT CARE Quick Start Reference Sheet UT CARE Quick Start Reference Sheet More Info on UT CARE Quick Start Reference Sheet
310. Qualified Status Change Events Change in Status More Info on 310. Qualified Status Change Events
Tips Caring for your Eyes Wearing Contacts Tips for Caring for your Eyes While Wearing Contacts More Info on Tips Caring for your Eyes Wearing Contacts
Superior Vision Mobile App Superior Vision Mobile App More Info on Superior Vision Mobile App
Prescriptions by Mail Order Form Prescriptions by Mail Order Form More Info on Prescriptions by Mail Order Form
Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form More Info on Prescription Drug Reimbursement Form / Coordination of Benefits Claim Form
UT SELECT Part D Evidence of Coverage UT SELECT Part D Evidence of Coverage More Info on UT SELECT Part D Evidence of Coverage
Delta Dental Newsletter Delta Dental e-Magazine Information More Info on Delta Dental Newsletter
Delta Dental Wellness Information Delta Dental Wellness Presentation 2022-2023 More Info on Delta Dental Wellness Information
New Retirement Manager Admin Login Guide to New Retirement Manager Admin Login More Info on New Retirement Manager Admin Login
Glossary of Health Coverage and Medical Terms Uniform Glossary of Health Coverage and Medical Terms More Info on Glossary of Health Coverage and Medical Terms
Purchase Change Agreement (All plans) UT Retirement Purchase Change Agreement (All plans) More Info on Purchase Change Agreement (All plans)
Annual Leave Deferral Agreement Annual Leave Deferral Agreement More Info on Annual Leave Deferral Agreement
Weathering the Storm Weathering the Storm More Info on Weathering the Storm
UTSaver Loan and Inservice Distribution Options UTSaver Loan and Inservice Distribution Options More Info on UTSaver Loan and Inservice Distribution Options
UT SELECT Medical Claim Form UT SELECT Medical Claim Form More Info on UT SELECT Medical Claim Form
Record of Revisions Record of Revisions More Info on Record of Revisions
570. UT FLEX Program UT FLEX Program More Info on 570. UT FLEX Program
Short Term Disability Brochure NEW! 2021-2022 Short Term Disability Brochure
2020-2021 Short Term Disability Brochure 		More Info on Short Term Disability Brochure