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	Carrier Forms & Documents

For your convenience, listed below are forms and important documents, as well as links to websites for UMR (Third Party Administrator for Medical), UnitedHealtcare Group (Medical Network), United Concordia (Dental), CareBridge (EAP), Sun Life (Life & Disability), and Humana (Vision).

If you are having difficulty accessing any of these sites, or need additional assistance please contact the EONE Benefit Advocate Team at mybenefits@eonebenefits.com or at (877) 719-3671.

Insurance Company Website and Information	Link
UMR (Third Party Administrator for Medical)	UMR Website
UMR Flyer	Online Flyer
UMR Find a Provider	Find a Provider
UMR - QHDHP/HSA	Questions about QHDHP/HSA
UMR Claims	Member Claim Submission Form
UMR ID Card	Understanding your ID Card
UMR Explanation of Benefits	Understanding your EOB
UMR Providers	Looking for Healthcare Provider
UMR Debit Card	Using your Debit Card
HSA Optum Banking	Optum Banking
HSA Account Transfer Form	HSA Form
United Concordia (Dental) (DPPO)	www.UnitedConcordia.com
United Concordia (Dental) (DPPO) Mobile App	Mobile App Flyer
United Concordia (Dental) (DHMO) Mobile App	Mobile App Flyer
United Concordia (Dental) (DHMO)	www.mysmile365.com
CareBridge (Employee Assistance Program)	www.carebridgenow.com
Humana (Vision Carrier)	www.humana.com
Humana Plan Information	Humana Vision
Humana Vision Discounts	Humana Discounts
Humana Vision Medical Conditions	Humana Vision Medical
Humana Plan FAQs	Humana Vision FAQs
Express Scripts Formulary	Helpful Information
Reliance Matrix (Life and Disability)	Basic Life Insurance Highlights
Reliance Matrix (Life and Disability)	How to file a short term disability claim
Reliance Matrix (Life and Disability)	Bereavement Support Services
Reliance Matrix (Life and Disability)	Identity Theft Benefit
Reliance Matrix (Life and Disability)	Short Term Disability Highlights
Reliance Matrix (Life and Disability)	Long Term Disability Highlights
Reliance Matrix (Life and Disability)	Travel Assistance Program
Reliance Matrix (Life and Disability)	Supplementary Dependent Life Insurance Highlights – Weekly Associates
Reliance Matrix (Life and Disability)	Supplementary Dependent Life Insurance Highlights – BiWeekly Associates

The forms below are available for your convenience or if required by the coverage you select.

Forms & Instructions	Link
Criteria for Domestic Partnership	Domestic Partnership Criteria
Affidavit of Domestic Partnership	Affidavit of Domestic Partnership

Click on the links below to access the forms. A PC with PDF reader is required to open and print these documents. These forms are not accessible from the Showroom Thin Client Neoware Computers.

Legal Documents & Summary Plan Descriptions	Link
UMR (MRF) Transparency in Coverage	Transparency in Coverage
Trustmark Summary Plan Description	Medical Plan SPD
Trustmark Health Benefits	Machine Readable Files
Summary of Benefits and Coverage	$750 PPO
Summary of Benefits and Coverage	Enhanced $250 PPO
Summary of Benefits and Coverage	HSA
Summary of Benefits and Coverage	Enhanced HSA
Summary of Benefits and Coverage	HRA
Annual Federal Notices & Required Enrollment Notices	2022 Annual Notices
Dental DHMO	Benefit Booklet
CompBenefits Plan Description (Vision)	Vision Plan
Wrap Plan Summary Plan Description	Wrap Plan SPD
Premium Only Plan Summary Plan Description	Premium Only Plan SPD
ERISA Compliance and Summary Annual Report	ERISA
Reliance Matrix (Life and Disability)	Long Term Disability 1 Certificate
Reliance Matrix	Long Term Disability 2 Certificate
Reliance Matrix	Short Term Disability Certificate
Reliance Matrix	Basic Life Insurance Certificate
Reliance Matrix	Basic Life Insurance Continuity Certificate

Please contact the Insurance and Risk Team for prior plan years SPD's.

Voluntary Plans	Link
The Hartford Hospital Indemnity	Hospital Indemnity
The Hartford Hospital Indemnity Insurance Benefits	Hospital Indemnity Highlights
The Hartford Accident Plan	Basic Accident Plan
The Hartford Accidental Insurance Benefits	Accidental Insurance Highlights
The Hartford Critical Illness	Critical Illness Booklet
The Hartford Critical Illness Insurance Benefits	Critical Illness Highlights
The Hartford Health Screening Benefit	Health Screening Benefit
The Hartford How to File a Voluntary Claim	How to File a Voluntary Claim
The Hartford Claims Form	Claims Form
The Hartford Limitations and Exclusions	Limitations and Exclusions
The Hartford Value Added Services	Value Added Services
Preferred Legal Plan	Preferred Legal Plan
ID Theft	Identity Theft Protection