Publications by Office

Employee Benefits
DocumentPublish DateFile
Getting Started with the Online Member PortalSuperior Vision Online Member Portal
Grandchild Certification FormGrandchild Certification Form
Group Term Life Benefits GuideGroup Term Life Benefits Guide
Helpful Hints for Completing the Direct Payment AgreementHelpful Hints for Completing the Direct Payment Agreement
HIPAA Breach LogHIPAA Breach Log
HIPAA Complaint FormHIPAA Complaint Form
HIPAA Disclosure LogHIPAA Disclosure Log
HIPAA General Authorization FormHIPAA General Authorization Form
HIPAA Hybrid Entity DesignationHIPAA Hybrid Entity Designation
HIPAA Notice of Privacy PracticesHIPAA Notice of Privacy Practices
HIPAA Policy 1.0: Introduction & DefinitionsHIPAA Policy 1.0: Introduction & Definitions
HIPAA Policy 2.0: Organization of System for HIPAA Privacy Standard Compliance PurposesHIPAA Policy 2.0: Organization of System for HIPAA Privacy Standard Compliance Purposes
HIPAA Policy 3.0: Breach Notification PolicyHIPAA Policy 3.0: Breach Notification Policy
HIPAA Policy 4.0: PHI Requests, Access, Uses and DisclosuresHIPAA Policy 4.0: PHI Requests, Access, Uses and Disclosures
HIPAA Policy 5.0: Office of Employee Benefits As a Plan SponsorHIPAA Policy 5.0: Office of Employee Benefits As a Plan Sponsor
HIPAA Policy 6.0: Relationships With Other EntitiesHIPAA Policy 6.0: Relationships With Other Entities
HIPAA Policy 7.0: Individual RightsHIPAA Policy 7.0: Individual Rights
HIPAA Policy 8.0: Ensuring Privacy ComplianceHIPAA Policy 8.0: Ensuring Privacy Compliance
HIPAA Policy 9.0: DocumentationHIPAA Policy 9.0: Documentation
HIPAA Policy Section 4.10: Verification of Requestor’s Identity and AuthorityHIPAA Policy Section 4.10: Verification of Requestor’s Identity and Authority
HIPAA Policy Section 4.11: Obtaining and Relying Upon an AuthorizationHIPAA Policy Section 4.11: Obtaining and Relying Upon an Authorization
HIPAA Policy Section 4.12: Personal RepresentativesHIPAA Policy Section 4.12: Personal Representatives
HIPAA Policy Section 4.13: De-identified InformationHIPAA Policy Section 4.13: De-identified Information
HIPAA Policy Section 4.14: Documentation of DisclosuresHIPAA Policy Section 4.14: Documentation of Disclosures
HIPAA Policy Section 4.1: Requests for PHIHIPAA Policy Section 4.1: Requests for PHI
HIPAA Policy Section 4.2: Access to System PHIHIPAA Policy Section 4.2: Access to System PHI
HIPAA Policy Section 4.3: Uses and Disclosures Required by LawHIPAA Policy Section 4.3: Uses and Disclosures Required by Law
HIPAA Policy Section 4.4: Discretionary Uses and Disclosures Without An AuthorizationHIPAA Policy Section 4.4: Discretionary Uses and Disclosures Without An Authorization
HIPAA Policy Section 4.5: Conducting Underwriting ActivitiesHIPAA Policy Section 4.5: Conducting Underwriting Activities
HIPAA Policy Section 4.6: Research Disclosures and UsesHIPAA Policy Section 4.6: Research Disclosures and Uses
HIPAA Policy Section 4.7: Making Notification DisclosuresHIPAA Policy Section 4.7: Making Notification Disclosures
HIPAA Policy Section 4.8: Review of Requests for Use or Disclosure Requiring Approval by the Privacy OfficerHIPAA Policy Section 4.8: Review of Requests for Use or Disclosure Requiring Approval by the Privacy Officer
HIPAA Policy Section 4.9: Minimum Necessary Standard for Uses and Disclosures of PHIHIPAA Policy Section 4.9: Minimum Necessary Standard for Uses and Disclosures of PHI
HIPAA Policy Section 6.1: Contracts With Business Associates Involving Office of Employment Benefits PHIHIPAA Policy Section 6.1: Contracts With Business Associates Involving Office of Employment Benefits PHI
HIPAA Policy Section 6.2: Contracts Involving PHI Entered into by System Offices that are Business Associates of OEB or other Covered Entities.Section 6.2: Contracts Involving PHI Entered into by System Offices that are Business Associates of OEB or other Covered Entitie
HIPAA Policy Section 6.3: Carriers Providing Group Health Plan CoverageHIPAA Policy Section 6.3: Carriers Providing Group Health Plan Coverage
HIPAA Policy Section 6.4: Agreements With Recipients of a Limited Data SetHIPAA Policy Section 6.4: Agreements With Recipients of a Limited Data Set
HIPAA Policy Section 7.1: Notice of Individual Rights Concerning PHIHIPAA Policy Section 7.1: Notice of Individual Rights Concerning PHI
HIPAA Policy Section 7.2: Right to Access Protected Health InformationHIPAA Policy Section 7.2: Right to Access Protected Health Information
HIPAA Policy Section 7.3: Requests to Amend PHIHIPAA Policy Section 7.3: Requests to Amend PHI
HIPAA Policy Section 7.4: Right to Receive an Accounting of DisclosuresHIPAA Policy Section 7.4: Right to Receive an Accounting of Disclosures
HIPAA Policy Section 7.5: Requests for Restrictions on Use and DisclosureHIPAA Policy Section 7.5: Requests for Restrictions on Use and Disclosure
HIPAA Policy Section 7.6: Requests for Confidential CommunicationsHIPAA Policy Section 7.6: Requests for Confidential Communications
HIPAA Policy Section 7.7: Right to Make A ComplaintHIPAA Policy Section 7.7: Right to Make A Complaint
HIPAA Policy Section 7.8: Right to Breach NotificationsHIPAA Policy Section 7.8: Right to Breach Notifications
HIPAA Policy Section 8.1: Cooperation With the Secretary’s InvestigationHIPAA Policy Section 8.1: Cooperation With the Secretary’s Investigation
HIPAA Policy Section 8.2: TrainingHIPAA Policy Section 8.2: Training
HIPAA Policy Section 8.3: Safeguarding PHIHIPAA Policy Section 8.3: Safeguarding PHI
HIPAA Policy Section 8.4: Mitigation of Known Privacy ViolationsHIPAA Policy Section 8.4: Mitigation of Known Privacy Violations
HIPAA Policy Section 8.5: Sanctions for Personnel Violations of PrivacyHIPAA Policy Section 8.5: Sanctions for Personnel Violations of Privacy
HIPAA Policy Section 9.1: Changes to Privacy Policies and ProceduresHIPAA Policy Section 9.1: Changes to Privacy Policies and Procedures
HIPAA Policy Section 9.2: Retention of Privacy DocumentationHIPAA Policy Section 9.2: Retention of Privacy Documentation
HIPAA Privacy Officer DesignationHIPAA Privacy Officer Designation
HIPAA Request for Access to Protected Health InformationRequest for Access Form
HIPAA Request for Accounting of DisclosuresHIPAA Request for Accounting of Disclosues Form
HIPAA Request for Amendment of Protected Health InformationHIPAA Request for Amendment of Protected Health Information Form
HIPAA Request for Confidential Communications of Medical InformationHIPAA Request for Confidential Communications of Medical Information Form
HIPAA Request for Restriction on Use or Disclosure of Protected Health InformationHIPAA Request for Restriction Form
HIPAA Revocation of AuthorizationHIPAA Revocation of Authorization Form
HIPAA Staff Assistance AuthorizationHIPAA Staff Assistance Authorization
International Travel Quick Reference Sheetut-system-foreign-coverage-quick-reference-sheet-12-2016.pdf
IntroductionIntroduction to OEB Administrative Manual
Legal NoticesUT Benefits - Legal Notices
Life Benefit Highlights for Retired EmployeesLife Benefit Highlights for Retired Employees
Life Conversion ApplicationApplication to Convert Group Life Insurance
Life Portability ApplicationLife Portability Application
Life/AD&D Benefit Highlights for Active EmployeesLife/AD&D Benefit Highlights for Active Employees
Long-Term Care Benefits Guideltcguide.pdf
Long-Term Care HighlightsLTC Highlights
Long-Term Care Outline of CoverageLTC Outline of Coverage
Long-Term Disability Benefit HighlightsLong-Term Disability Benefit Highlights
Long-Term Disability Benefits GuideLong Term Disability Guide
Long-Term Disability Conversion KitLTD Conversion Kit
LTD Conversion CalculatorLTD Conversion Calculator
LTD Employee Claim FormLTD Employee Claim Form
LTD Employer Claim FormLTD Employer Claim Form
Medicaid and the Children's Health Insurance Program (CHIP) NoticeMedicaid and CHIP Notice
Notice of Creditable Coverage (NOCC)Medicare Part D Notice of Creditable Coverage
Optional Retirement Program (ORP) Plan DocumentOptional Retirement Program (ORP) Plan Document
ORP AcknowledgementORP Acknowledgement