Enrollment Forms

• UUA Insurance Plans Benefit Enrollment form (for all insurances)

• Dental Enrollment form (PDF) for all states except Texas
• Dental Enrollment form (PDF) for Texas residents only
• Life and Long-Term Disability (LTD) Enrollment Form (PDF)
• Accident and Hospital Indemnity Enrollment Form

Report Employee Changes Forms

• Report Employee benefit changes (online)
• Report a transfer from one UU Congregation or organization to another (online)

For Congregational Administrators

• Monthly required health plan contribution report ("splits form")

Health Insurance

• Medicare waiver letter template (Word) (for congregations)

Dental Insurance Plan

• Guardian Dental Plan Highlights (PDF)

Life and Long Term Disability Insurance

• Long Term Disability (LTD) Frequently Asked Questions (PDF)
• Guardian Policy Rider (PDF)
• Guardian Life & LTD Certificate Booklet (PDF)
• LTD Claim Direct Pay Form (PDF)
• Guardian LTD Claim Submission Process Form (PDF)
• Guardian Social Security Your Other Disability Insurance (PDF)
• Guardian Evidence of Insurability Form (PDF)

Accident and Hospital Insurance

• Voluntary Accident Coverage
• Hospital Indemnity Insurance

Employee Assistance Program

• Employee Assistance Program Overview (PDF)
• Employee Assistance Program Contacts Information (PDF)

Vision Benefits

• EyeMed Benefits Summary (PDF)