UUA Insurance Plans Forms & Resources
Enrollment Forms
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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)
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)
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)