City Furniture LearnCenter -Powered by Taleo Learn

	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), UnitedHealthcare Group (Medical, Dental, Vision, and Voluntary Plan Networks), Reliance Matrix (EAP and Life & Disability), and more.

If you are having difficulty accessing any of these sites, or need additional assistance please contact the CUNDY Customer Success Team at CustomerSuccessTeam@cundy.com or at 1-800-88CUNDY (1-800-882-8639).

Insurance Company Website and Information	Link
United Healthcare (Dental) (DPPO)	www.myuhc.com
United Concordia (Dental) (DPPO)	UHC Dental Welcome
United Healthcare (Dental) (DPPO)	Enhance Coverage
United Healthcare (Dental) (DPPO)	UHC FAQs
United Healthcare (Dental) (DPPO)	UHC Virtual Care
United Healthcare (Dental) (DHMO)	www.mysmile365.com
Reliance Matrix (Employee Assistance Program)	https://rsli.mylifeexpert.com/
United Healthcare (Vision)	www.myuhcvision.com
United Healthcare (Vision)	UHC_Contact_Lense_Benefits.pdf
United Healthcare (Vision)	Vision Additional Benefits
United Healthcare (Vision)	Vision Network
United Healthcare (Vision)	UHC Vision Welcome
United Healthcare (Vision)	Vision Express Exam
United Healthcare (Vision)	Warby Park
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	Secondary Insurance Flyer
UMR ID Card	Understanding your ID Card
UMR Preferred Labs	Preferred Labs
UMR Explanation of Benefits	Understanding your EOB
UMR Providers	Looking for Healthcare Provider
UMR Provider Search and Cost Transparency	Looking for Provider and Cost Transparency
HSA Optum Banking	Optum Banking
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)	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
United Healthcare (Dental) (DHMO)	DHMO Benefits Summary
United Healthcare (Dental) (DPPO)	DPPO Benefits Summary
United Healthcare (Vision)	Vision Benefits Summary
United Healthcare (Accident Plan)	Accident Benefits Summary Weekly
United Healthcare (Accident Plan)	Accident Benefit Summary Biweekly
United Healthcare (Accident Plan - Option A)	Accident Plan - Option A
United Healthcare (Accident Plan - Option B)	Accident Plan - Option B
United Healthcare (Critical Illness Plan)	Critical Illness Summary Weekly
United Healthcare (Critical Illness Plan)	Critical Illness Summary Bi-weekly
United Healthcare (Critical Illness Plan)	Critical Illness Certificate of Coverage
United Healthcare (Hospital Indemnity)	Hospital Indemnity Summary Weekly
United Healthcare (Hospital Indemnity)	Hospital Indemnity Summary Biweekly
United Healthcare (Hospital Indemnity - NON HSA)	Hospital Indemnity NON HSA
United Healthcare (Hospital Indemnity HSA)	Hospital Indemnity HSA
UMR (MRF) Transparency in Coverage	Transparency in Coverage
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 Material Reduction in Covered Services or Benefits	2024 - 2025 Plan Year Notices
Health Plan Compliance Notices	2024 Notices
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
UMR Summary Plan Description	Medical Plan SPD

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

Voluntary Plans	Link
Preferred Legal Plan	Preferred Legal Plan
ID Theft	Identity Theft Protection
United Healthcare Voluntary Benefits	www.myuhc.com
United Healthcare Voluntary Benefits	UHC Claims Process
United Healthcare Voluntary Benefits	File a Claim – Financial Protection
United Healthcare Voluntary Benefits	UHC Portal
United Healthcare Voluntary Benefits	UHC Claims Form
United Healthcare (Accident Plan)	Accident Protection Plan
United Healthcare (Critical Illness Plan)	Critical Illness Protection Plan
United Healthcare (Hospital Indemnity)	Hospital Indemnity Protection Plan