Forms and Publications
General benefits-related
- 2012 Benefits News
- 2012 COBRA Rates
- 2012 Union COBRA Rates
- Notification of COBRA Qualifying Event
- ERISA Summary Plan Description
Medical/HMO/dental
- Waiver of Coverage
- USC Network Medical Plan 2012 Booklet
- USC Network HealthComp Welcome Brochure
- USC Network Claim Form
- CVS Pharmacy Claims
- Vision Benefit Summary
- Kaiser Evidence of Coverage
- Anthem Blue Cross CaliforniaCare
- Anthem 360 Health Programs overview
- Anthem 24/7 NurseLine
- Anthem Pharmacy Formulary list
- Anthem Future Moms information
- Anthem website information
- Anthem Healthy Living website information
- UnitedHealthcare Medical
- UnitedHealthcare Rx
- UnitedHealthcare Mental Health
- Anthem Blue Cross $200 PPO Info Kit (CNA)
- Anthem Blue Cross $200 PPO Plan (CNA)
- Anthem Blue Cross $400 PPO Info Kit (NUHW)
- Anthem Blue Cross $400 PPO Plan (NUHW)
- Anthem Blue Cross $800 PPO Info Kit (CNA and NUHW)
- Anthem Blue Cross $800 PPO Plan (CNA and NUHW)
- Anthem Blue Cross HMO Info Kit (CNA and NUHW)
- Anthem Blue Cross HMO (CNA and NUHW)
- Delta Dental Highlights
- Delta Dental Claim Form
- United Concordia Evidence of Coverage
- United Concordia Evidence of Coverage—California
- Plan C Reimbursement Form
- Medicare Information
Financial/insurance/flexible spending
- Hyatt Legal Plan
- Hyatt Legal Fee Schedule
- Hyatt Legal Fact Sheet
- Minnesota Life Group Universal Life Insurance Plan
- Minnesota Life Variable Group Universal Life Insurance Plan
- Flexible Spending Account Health Care Claim Form
- Flexible Spending Account Dependent Care Claim Form
- Flexible Spending Account Orthodontia Guidelines
- UNUM Portability Information
- UNUM Portability Rates
- UNUM Portability Form
- UNUM Conversion Form-California
- UNUM Conversion Rates
- UNUM Beneficiary Designation Form
Retirement
- USC Retirement Savings Program Summary Plan Description
- Authorization to Release Information
- Fidelity Basic Loan Application
- Fidelity Supplemental Loan Application
- Prudential Enrollment Form
- Prudential Beneficiary Form, Part I (Employee)
- Prudential Beneficiary Form, Part II (Employer)
- Prudential Loan Application 401(a) Plan
- Prudential Loan Application 403(b) Supplemental Plan
- Prudential Loan Payment Authorization
- USC Non-Exempt Staff Retirement Plan (frozen 6/30/07)
- USC Defined Contribution Retirement Plan Summary Annual Report
- USC Support Staff Retirement Plan Summary Annual Report
- USC Tax Deferred Annuity Plan Summary Annual Report
- USC Hospital 401(k) Plan (union) Summary Annual Report
Tuition Assistance
- Tuition Assistance Benefit Program Document
- Child or Spouse/Domestic Partner
- Child of Employee with 15+ Years
- Faculty
- Staff/Admitted Student
- Staff/Job-Related Audit
- ROTC
- Payroll forms