FORMS & DOCUMENTS

Forms & Documents

MY HEALTH

• UnitedHealthcare Medical Claim Form
• BCBSIL Medical Claim Form
  
• CVS/caremark Prescription Reimbursement Claim Form
  
• UnitedHealthcare: How to Get the Most Out of Your Health Plan
  
• Letter to Physician
  
• Prescription Drug Maintenance Medication Program
• Dental Claim Form - English
• Cigna Dental (DHMO) Patient Charge Schedule
  
• Cigna Dental (DHMO) Economical, Easy-to-Use Dental Coverage
  
• Cigna Dental Benefit Summary DPPO
  
• Cigna Dental Benefit Summary DPPO Texas
  
• Cigna Dental Benefit Summary DPPO Plus
  
• Cigna Dental Benefit Summary DPPO Plus Texas
  
• Cigna Dental Benefit Summary DPPO Plus Esselte Retirees
  
• Cigna Dental Benefit Summary DPPO Plus Esselte Retirees MS/LA
  
• EyeMed Vision Care Services
  
• Hearing Discount Member Flyer

MY MONEY

• 2021 Guide to Your Health Savings Account
  
• Investing Your HSA
• Payroll FAQ

NEW HIRES AND ANNUAL ENROLLMENT

• 2021 Retiree Benefits Guide
• 2021 Retiree Group Health Program Comparison Chart
• Important Considerations Regarding Medicare & RRD Coverage

INFORMACIÓN EN ESPAÑOL

LEGAL NOTICES

• Notice of Privacy Practices Under HIPAA

SUMMARY PLAN DESCRIPTIONS (SPDs)

• Key Provisions: COVID-19 & Your RRD Benefits SMM
  

MEDICAL AND PRESCRIPTION DRUG PROGRAMS

• 2020 Group Benefits Plan and Flexible Benefits Plan SMM
• 2018–2019 Group Benefits Plan and Flexible Benefits Plan SMM
• Medical and Prescription Drug Programs SPD
• Medical and Prescription Drug Programs Appendices
• 2017 Medical and Prescription Drug SMM
• 2016 Medical and Prescription Drug SMM
• 2016 Group Benefits Plan SMM
• 2015 Group Benefits Plan SMM

REGIONAL MEDICAL OPTIONS PROGRAM

• Regional Medical Options Program Wrap Document
• Dean Health Plan Schedule of Benefits
• Dean Health Plan - Prevea360 Schedule of Benefits
• Kaiser Permanente Deductible HMO Plan for Northern California Region - Evidence of Coverage
• Kaiser Permanente HSA/HDHP HMO Plan for Northern California Region – Evidence of Coverage
• Kaiser Permanente Deductible HMO Plan for Southern California Region - Evidence of Coverage
• Kaiser Permanente HSA/HDHP HMO Plan for Southern California Region – Evidence of Coverage
• Kaiser Permanente Deductible HMO Plan for Oregon Region - Evidence of Coverage
• Kaiser Permanente HSA/HDHP HMO Plan for Oregon Region – Evidence of Coverage
• Blue Cross Blue Shield of IL HMO Certificate of Coverage

SUPPLEMENTAL BENEFITS PROGRAM

• Supplemental Benefits Program ERISA Information
• Accident Policy
• Accident Insurance Plan Summary
• Critical Illness Policy
• Critical Illness Insurance Plan Summary
• Hospital Policy
• Hospital Indemnity Insurance Plan Summary

DENTAL BENEFIT PROGRAM

• Dental Benefit Program SPD
• Cigna Certificate of Coverage - Dental PPO
• Cigna Certificate of Coverage - Dental PPO Plus
  
• Cigna Certificate of Coverage - Dental HMO
  
• 2017 Dental SMM

VISION CARE PROGRAM

• Vision Care Program SPD
• EyeMed Certificate of Coverage
• 2017 Vision SMM

HEALTH CARE FSA AND DEPENDENT DAY CARE FSA

• 2020 Group Benefits Plan and Flexible Benefits Plan SMM
• 2018–2019 Group Benefits Plan and Flexible Benefits Plan SMM
• Health Care and Dependent Care Spending Programs SPD
• 2017 FSA SMM

LIFE INSURANCE

• Life and Accident Insurance Program Summary of Benefits
• Life and Accident Insurance Program SPD
• Life Certificate of Coverage and Schedule of Benefits for Employees Not Eligible Under Class 2 Through 5
  
• All Guaranty Association Notices
  

SHORT-TERM DISABILITY

• Short-Term Disability Program SPD
• 2017 STD SMM

LONG-TERM DISABILITY

• Long-Term Disability Program SPD
• Certificate for AFTA and Union Employees
• Certificate for Sales Representatives

SAVINGS

• Savings Plan SPD
• Savings Plan SMM January 2017
• Savings Plan SMM June 2016
• Savings Plan SMM May 2015
• Savings Plan 5500

PENSION

All (with the exception of Puerto Rico)

• Pension Plan SPD - RR Donnelley - Part B - All Components
• Annual Funding Notice
• Savings Plan SMM - All Components January 2017

RR Donnelley

• Pension Plan SPD - RR Donnelley - Part A - RR Donnelley Component
• SMM – RR Donnelley June 2016

Moore Wallace

• Pension Plan SPD - Moore Wallace (Pre 2005)
• Pension Plan SPD - Moore Wallace (Post 2005)
• SMM - Moore Wallace (Pre 2001) June 2016
• SMM - Moore Wallace June 2016

Bowne

• Pension Plan SPD - Bowne
• SMM - Bowne June 2016
• 5500 - Bowne

Banta Salaried

• Pension Plan SPD - Banta Employees
• SMM - Banta Salaried June 2016

Banta Hourly

• Pension Plan SPD - Banta Hourly - Specialty Converting
• Pension Plan SPD - Banta Hourly - Book Group
• Pension Plan SPD - Banta Hourly - Danbury
• SMM - Banta Hourly Specialty Converting June 2016
• SMM - Banta Hourly Book Group June 2016
• SMM - Banta Hourly Danbury June 2016

Haddon Craftsmen, Inc.

• Pension Plan SPD - Haddon
• SMM - Haddon June 2016

Cardinal Brands

• Pension Plan SPD - Cardinal Brands
• SMM - Cardinal Brands June 2016

Check Printers

• Pension Plan SPD - Check Printers
• SMM - Check Printers June 2016

Puerto Rico

• Pension Plan - Puerto Rico
• SMM - Puerto Rico June 2014
• SMM - Puerto Rico May 2015
• 5500 – Puerto Rico
• Annual Funding Notice – Puerto Rico

QUALIFIED STATUS CHANGES

• 2020 Reduction in Hours Qualified Status Changes SMM
• Qualified Status Changes SPD
• 2017 Qualified Status Changes SMM

EMPLOYEE ASSISTANCE PROGRAM (EAP)

• Employee Assistance Program Brochure
• Employee Assistance Plan SPD

SEPARATION PAY

• Separation Pay Plan SPD

GENERAL

• Summary Plan Descriptions (SPDs) and 2015 Summaries of Material Modifications (SMMs)
• Group Benefits Plan 2015 SMM

RETIREE MEDICAL & LIFE INSURANCE

• Basic Life Insurance Booklet for Retirees Who Separated on or After 1-1-2016 and Before 10-1-2016
• Basic Life Insurance Booklet for Retirees of Former Cardinal Brands
• Basic Life Insurance Booklet for Union Employees Who Retired Before 1-1-2016
• Basic and Optional Life Insurance Booklet for Retirees Who Separated Before 1-1-2016
• Retiree Medical and Drug Benefit Program SPD
• 2020 Retiree Medical and Drug Benefit Program SMM
• Medicare Advantage Plan Guide ‒ $400 Deductible
• Medicare Advantage Plan Guide ‒ $275 Deductible
• Medicare Advantage Plan Guide ‒ $200 Deductible
• Wellmark Certificate
• Wellmark Overview of Coverage
• Retiree Group Life SPD
• 2020 Retiree Group Life SMM
• Important Information if You Are Retiring on or after October 1, 2016
• Summary of Benefits for SilverScript Prescription Drug Plan (RR Donnelley/UHC)
• Opt-Out Notice for SilverScript Prescription Drug Plan
• Wellmark Health Insurance Brochure

2021 Summaries of Benefits & Coverage (SBCs)