Plan Documents and Forms
2024–2025 Benefit Year Documents
2024 Anthem HMO Medical Plan Benefits Summary [PDF]
2024 Anthem PPO Medical Plan Benefits Summary [PDF]
2024 UCD Benefits Brochure [PDF]
2024 UCSD Benefits Brochure [PDF]
2024 UCSF Benefits Brochure [PDF]
2024 UCLA Benefits Brochure [PDF]
2024 UCI Benefits Brochure [PDF]
2023–2024 Benefit Year Documents
2024 FSA Summary Plan Description
2023 Anthem HMO Medical Plan Benefits Summary [PDF]
2023 Anthem PPO Medical Plan Benefits Summary [PDF]
2023 FSA Summary Plan Description [PDF]
2023 New York Life AD&D (Non-U.S. Citizen) Benefit Summary [PDF]
2023 New York Life AD&D (U.S. Citizen) Benefit Summary [PDF]
2023 New York Life Life Insurance (Non-U.S. Citizen) Benefit Summary [PDF]
2023 New York Life Life Insurance (U.S. Citizen) Benefit Summary [PDF]
2023 New York Life Long-Term Disability (Non-U.S. Citizen) Benefit Summary [PDF]
2023 New York Life Long-Term Disability (U.S. Citizen) Benefit Summary [PDF]
2023 New York Life Short-Term Disability (Non-U.S. Citizen) Benefit Summary [PDF]
2023 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
![uc-tfc-nov20-wb-bnnr-cmmrcl-533x533](https://www.ucresidentbenefits.com/wp-content/uploads/2022/05/uc-tfc-nov20-wb-bnnr-cmmrcl-533x533-1.png)