Benefit Notices

Benefit Notices

Pacific provides legally required documents from time to time as required by law but to also assist you and your dependents to better understand and utilize your benefit plans to the fullest. Below are documents you may want to review and refer to:

 

Notice of Rights

• Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)
• Important Notice for Medicare Eligible Participants (Credible Coverage)
• Notice of Privacy Practices
• 2018 Legal Notices-Health Plan Coverage
• VSP Grievance Process
• WC Rights and Time of Hire Pamphlet (Return Pre-designation of Personal Physician to your HR office)
• Voluntary Disability Plan Opt Out

Summary Annual Reports

• Summary Annual Report-University of the Pacific Defined Contribution Retirement Plan

• Summary Annual Report-Group Health and Welfare

 San Francisco Health Ordinance

• San Francisco Fair Chance Ordinance
• San Francisco Designated Person Form
• San Francisco Health Ordinance Waiver Form

San Francisco Paid Parental Leave

• Paid Parental Leave Ordinance Poster
• SF Paid Parental Leave Ordinance Rules
• SF Paid Parental Leave Form
• Calculation Instructions

Benefit Plan Documents

• Summary Plan Description-Health and Welfare plan
• Voluntary Life and AD&D / Long Term Disability- Liberty Mutual
  • Life Policy
  • Disability Certificate of Coverage
  • Disability Policy
• Retirement plan 
  • Summary Plan Description 403b
  • Adoption Agreement with Amendments
  • Other Plan Information 
  • w/Roth Amendment
  • Hardship Withdrawal form
• Summary Plan Description-Transportation Plan w/ Amendment
• Summary Plan Description- California Voluntary 
• Summary Plan Description- University of the Pacific Flexible Benefit Subplan and Amendment
• FSA Summary of Material Modification - Amendment to Flexible Benefit Subplan
• SPD Summary of Material Modification - Amendment to Self-Funded Medical Plan
• Summary of Material Modification - Amendment to the Group Health Plan for Employees
• UNUM - Accident Policy Certificate of Coverage 
• VSP- Evidence Certificate of Coverage

Other Helpful links

• Retirement Plan Services and Costs (or go to www.tiaa.org/planinvestmentoptions , enter plan ID 100185)
• Staff Handbook
• Faculty Handbook
• Medical/Vision Plan Information
• Dental Plan Information

 

 

 

 

 

 

 

 

 

 

 

 

 

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