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Use the menu below to view and download forms and documents related to each plan

Document Tree

• a. Medical Plan Details and Documents
  • Blue Shield Details 2012
    • Blue Shield EPO Plan.pdf
    • Blue Shield HDHP 2000 Plan.pdf
    • Blue Shield PPO 500 Plan.pdf
  • Blue Shield Details 2013
    • Blue Shield EPO Benefit Booklet.pdf
    • Blue Shield EPO Plan Summary.pdf
    • Blue Shield EPO SBC.pdf
    • Blue Shield HDHP Benefit Booklet.pdf
    • Blue Shield HSA 2000 Plan Summary.pdf
    • Blue Shield HSA 2000 SBC.pdf
    • Blue Shield PPO 500 Plan Summary .pdf
    • Blue Shield PPO 500 SBC.pdf
    • Blue Shield PPO Benefit Booklet.pdf
  • Blue Shield Forms
    • Blue Shield BlueCard International Claim Form.pdf
    • Blue Shield Disability Addendum.pdf
    • Blue Shield Mail Order Form.pdf
    • Blue Shield Overage Dependent Form.pdf
    • Blue Shield Privacy Notice.pdf
    • Blue Shield RX Claim Form.pdf
  • Plan Features
    • Be Healthy and SAVE.pdf
    • Blue Shield Complex Care Management Program.pdf
    • Blue Shield Global and Out-of-area Travel.pdf
    • Blue Shield Nurse Help.pdf
    • Blue Shield Prenatal Care program.pdf
    • Blue Shield Support for Health Conditions.pdf
    • NU Auto Contribution in Employee HSA.pdf
  • Access Your Benefits Online.pdf
• b. Dental Plan Details and Documents
  • Current 2012 Dental Plans
    • DHMO 05968 DeltaCare Summary of Benefits.pdf
    • DHMO DeltaCare Evidence of Coverage.pdf
    • Delta Dental Annual Notices.pdf
    • Delta Dental Claim Form.pdf
    • Delta Dental Online Features.pdf
    • PPO 15881 Delta Dental Summary of Benefits.pdf
    • PPO Delta Dental Evidence of Coverage.pdf
  • New 2013 Dental Plans Effective July 1, 2013
    • Delta Dental Annual Notices.pdf
    • Delta Dental DHMO Plan Summary.pdf
    • Delta Dental PPO Plan Summary.pdf
    • Delta Dental Plan Options.pdf
    • PPO Delta Dental Evidence of Coverage.pdf
• c. Vision Plan Details and Documents
  • VSP Evidence of Coverage.pdf
  • VSP Laser Care.pdf
  • VSP Vision Summary.pdf
  • VSP_Out_of_Network_Claim_Form.pdf
• d. Employer Paid Life and Disability Details and Documents
  • Life Insurance
    • Reliance Community_Property_Spousal_Consent.pdf
    • Reliance Employer Paid Life Summary.pdf
    • Reliance Life Conversion Form.pdf
    • Reliance Portability Form.pdf
    • What_is_GTL.pdf
  • Long Term Disability Insurance
    • Employer_Paid_LTD_All_Others.pdf
• e. Voluntary Benefits Details and Documents
  • Accident Insurance
    • Accident_Wellness_Benefit_Claim_form.pdf
  • Cancer Insurance
    • Cancer_Diagnostic_Testing_Claim_form.pdf
  • Pet Insurance
    • Avian Plan Benefit Schedule.pdf
    • Pet Insurance Brochure.pdf
    • Pet Insurance Claim Form.pdf
    • Pet Insurance Enrollment Instructions.pdf
    • Pet Insurance Fact Sheet.pdf
    • Pet Insurance Well Care Rider.pdf
    • Standard Pet Plan Benefit Schedule.pdf
    • Superior Pet Plan Benefit Schedule.pdf
  • Short Term Disability
    • Short Term Disability Brochure.pdf
    • Short Term Disability Rates All Other States.pdf
    • Short Term Disability Rates California.pdf
  • Supplemental_Life_Insurance
    • Reliance_Standard_Voluntary_Life_Rate_Grid.pdf
    • Reliance_Standard_Voluntary_Supplemental_Life.pdf
• f. Flexible Spending Account Details and Documents
  • Health Equity Dependent Care FAQ.pdf
  • Health Equity Dependent Care Reimbursement Form.pdf
  • Health Equity FSA Reimbursement Form.pdf
  • Health Equity FSA Welcome Kit.pdf
  • Health Equity Limited FSA Guide.pdf
  • HealthEquity FSA Overview (new).pdf
  • HealthEquity FSA TAX WORKSHEET (new).pdf
  • HealthEquity FSAFAQs (new).pdf
  • Section 125 Life Change Events.pdf
• g. Discount Programs
  • Membership Banking Discount Program.pdf
• h. Retirement Program Details and Documents
  • Emerti
    • EMERITI - 5 Ways to get more information.pdf
    • EMERITI - ADV Privacy Notice.pdf
    • EMERITI - HIPAA Privacy Notice.pdf
    • EMERITI - Summary Plan Description - National University.pdf
    • Emeriti 7 WAYS .pdf
    • Emeriti Bold New Directions .pdf
    • Emeriti Rates National.pdf
  • Lincoln
    • Lincoln Alliance Contacts.pdf
    • Lincoln_403b_Contract_Exchange.pdf
    • Lincoln_Cover_Letter.pdf
    • Lincoln_Forms_Instructions.pdf
    • Lincoln_How_To_Enroll.pdf
    • Lincoln_LifeSpan.pdf
    • Lincoln_Plan_Highlights.pdf
    • Lincoln_Privacy_Notice.pdf
    • Lincoln_QDIA_Notice.pdf
    • Lincoln_Roll_Over_Request.pdf
    • Lincoln_Roth_Contribution.pdf
    • Lincoln_Safe_Harbor_Matching_Contribution.pdf
  • TIAA CREF
    • 403(b)TIAAEnrollmentForm.pdf
    • TIAA Enrollment Kit.pdf
    • TIAA How To Enroll.pdf
    • TIAA_Cref_Rollover_Transfer_or_Exchange_Form.pdf
  • 2013 Formula to Calculate Contribution Percent for the IRS Maximum.pdf
  • 403b Employer Matching Schedule.pdf
  • IRS_2013_Plan_Contribution_and_Benefit_Limits.pdf
  • NU 2013 Salary Reduction Agreement.pdf
  • NU 403NU 403b Summary Plan Document.pdf
  • NU Retirement Safe Harbor Notice.pdf
  • NU_Retirement_Contribution_Calculator.pdf
  • NU_Retirement_Savings_Plan_FAQ.pdf
  • Roth versus PreTax.pdf
• i. Wellness Program
  • Completing Your Health Assessment and Biometric Screening.pdf
  • Creating Your Viverae Wellness Account.pdf
  • NU Wellness FAQ.pdf
  • NU Wellness Incentive Program Flyer.pdf
• j. Employee Assistance Program
  • Concern EAP Evidence of Coverage.pdf
  • Concern Elder Care Plan.pdf
  • Concern Employee Assistance Plan (EAP) Services.pdf
  • ID_Theft._Program.pdf
  • Travel_Assistance_Program.pdf
• k. Enrollment Details and Documents
  • Job Aid - Benefit Enrollment.pdf
• l. Annual Employer Notices
  • 2011-12 NU Summary Annual Report.pdf
  • Children's Health Insurance Program (CHIP).pdf
  • Healthcare_Reform_Notice.pdf
  • Job Aid - Benefit Enrollment-1.pdf
  • Medicare_Part_D_Notification.pdf
  • Women_and_Cancer.pdf
  • Women_and_Newborn.pdf