UUA Insurance Plans Forms & Resources
Enrollment Forms
- UUA Insurance Plans Benefit Enrollment form (for ALL insurances)
- Life and Long-Term Disability (LTD) Enrollment Form (PDF)
- Accident and Hospital Indemnity Enrollment Form (PDF)
Report Employee Changes Forms
For Congregational Administrators
- Health Plan Contribution Report (“Splits Form”)
- *required annually
Health Insurance
- Medicare Waiver Letter template (Word) (for congregations)
- Calculate Your Monthly Premium
- Glossary of Health Insurance Terms (PDF)
- Overview of Benefits for Highmark members (PDF)
- Highmark Member Website Information (PDF)
- TeleDoc Behavioral Health Access (PDF)
- TeleDoc Dermatology Access (PDF)
- Wellness 360 Connect Information (PDF)
- Sharecare Digital Health Hub Information (PDF)
- Baby BluePrints Information (PDF)
- Highmark Home Delivery Prescription Information (PDF)
- Highmark Prescription Drug Formulary
- List of Medications NOT covered (PDF)
- Highmark Prescription Request Form (PDF)
Dental Insurance Plan
Life and Long Term Disability Insurance
- Life Benefit Summary (PDF)
- LTD Benefit Summary (PDF)
- 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
Employee Assistance Program