INTRODUCTION

ANNUAL OPEN ENROLLMENT

BENEFITS OVERVIEW

BENEFIT GRIDS AND NOTICES
UPMC Medical Grid

Gold EPO $1,500 $40/$50

UPMC Medical Grid

Gold EPO $1,500 $40/$50

UPMC Dental Grid

Premium 100/80/50/$0/$1,500/Ortho $1,000

UPMC Dental Grid

Premium 100/80/50/$0/$1,500/Or ...

UPMC Vision Grid

Prime Plus with Copay

UPMC Vision Grid

Prime Plus with Copay

Reliance Standard Life/AD&D

Certificate

Reliance Standard Life/AD&D

Certificate

Reliance Standard Life/AD&D

Benefit Grid

Reliance Standard Life/AD&D

Benefit Grid

Reliance Standard Long Term Disability

Benefit Grid

Reliance Standard Long Term Disability

Benefit Grid

ACTION REQUIRED

Employee Benefit Notices

Health Compliance Notices

Employee Benefit Notices

Health Compliance Notices

Section 125 Form

Section 125 Form

UPMC Summary of Benefits and Coverage

Gold EPO $1,500 $40/$50 SBC

UPMC Summary of Benefits and Coverage

Gold EPO $1,500 $40/$50 SBC

HOW TO ENROLL

ENROLLMENT FORM
UPMC

Employee Enrollment/Change Form

UPMC

Employee Enrollment/Change For ...

Reliance

Enrollment Form - Basic

Reliance

Enrollment Form - Basic

Reliance

Beneficiary Form

Reliance

Beneficiary Form

NEW HIRES

NEW HIRE ENROLLMENT INFORMATION

CONSIDERING MEDICARE COVERAGE?

Medicare 101

Medicare 101

CONTACT US

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