Other benefits
Forms + documents
Quick access to your plan materials
Find all your plan documents — all in one place
Don’t waste time shifting through internet tabs or paperwork. We’ve put together a list of all the info you need.
Not finding a specific form? Reach out to your Human Resources team
Insurance plan documents
- Employee Benefit Plan Document (PDF)
- Flexible Benefits Plan Document (PDF)
- Dental Standard Summary Plan Description (PDF)
- Dental Plus Summary Plan Description (PDF)
- Group Vision Care Policy (PDF)
- Life and Long-Term Disability Certificate of Insurance (PDF)
- Accident Insurance Plan Document (PDF)
- Critical Illness Plan Document (PDF)
- Hospital Indemnity Plan Document (PDF)
- Business Travel Accident Policy (PDF)
- 401(k) Summary Plan Description (PDF)
- Salary Continuation Plan Document (PDF)
- Medica Group Medicare Plan Summary Plan Description (PDF)
- Medical Plan Documents
Forms
- Adoption Assistance Program Request for Reimbursement Form (PDF)
- 2024 Declaration of Domestic Partnership (PDF)
General documents and notices
- 401(k) Safe Harbor Notice (PDF)
- COBRA Coverage Notice (PDF)
- Federal Exchange Notice (PDF)
- FAQ for Departing Employees (PDF)
- HIPAA Privacy Notice (PDF)
- Medicare Part D Creditable Coverage Notice - Medica members (PDF)
- Medicare Part D Creditable Coverage Notice – Dean Health (PDF)
- MNsure Exchange Notice (PDF)
- Participant Disclosure Document (PDF)
- Premium Assistance Under Medicaid and CHIP Notice (PDF)
- Special Enrollment Notice (PDF)
- The Hartford Annual Customer Privacy Policy (PDF)
Qualifying change in status documents
Questions?
We can help. Please visit the HR Service Center and submit a Human Resources question.