Plan Documents and Forms
2022–2023 Benefit Year Documents
2022 Anthem HMO Medical Plan Benefits Summary [PDF]
2022 Anthem HMO Summary Plan Description [PDF]
2022 Anthem PPO Medical Plan Benefits Summary [PDF]
2022 Anthem PPO Summary Plan Description [PDF]
2022 UCD Benefits Brochure [PDF]
2022 UCSD Benefits Brochure [PDF]
2022 UCSF Benefits Brochure [PDF]
2022 UCLA Benefits Brochure [PDF]
2022 UCI Benefits Brochure [PDF]
2022 UCR Benefits Brochure [PDF]
2022 Delta Dental Evidence of Coverage [PDF]
2022 Delta Dental Plan Highlights [PDF]
2022 Delta Dental Pre-Treatment Estimate [PDF]
2022 FSA Summary Plan Description [PDF]
2022 VSP Benefits Summary [PDF]
New York Life AD&D (Non-U.S. Citizen) Benefit Summary [PDF]
New York Life AD&D (U.S. Citizen) Benefit Summary [PDF]
New York Life Life Insurance (Non-U.S. Citizen) Benefit Summary [PDF]
New York Life Life Insurance (U.S. Citizen) Benefit Summary [PDF]
New York Life Long-Term Disability (Non-U.S. Citizen) Benefit Summary [PDF]
New York Life Long-Term Disability (U.S. Citizen) Benefit Summary [PDF]
New York Life Short-Term Disability (Non-U.S. Citizen) Benefit Summary [PDF]
New York Life Short-Term Disability (U.S. Citizen) Benefit Summary [PDF]
Forms
2022 Long Term Disability Conversion Form
New York Life AD&D Beneficiary Form
New York Life Group Benefits Claim Form
New York Life How to File a Disability Claim Brochure
New York Life How to File a Life or AD&D Insurance Claim Brochure
New York Life Life Insurance Beneficiary Form
New York Life Life Insurance Claim Form
