FORMS & DOCUMENTS

Forms & Documents

MY HEALTH

• PrudentRx Solution for Specialty Medications
• BCBSIL Medical Claim Form
  
• CVS/caremark Prescription Reimbursement Claim Form
  
• 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

• 2022 Guide to Your Health Savings Account
  
• 2021 Guide to Your Health Savings Account
  
• Investing Your HSA
• Payroll FAQ

LIFE CHANGES

• Leaving RRD: A Benefits Resource Guide
• Getting Ready to Retire: A Benefits Resource Guide

NEW HIRES AND ANNUAL ENROLLMENT

• 2022 Benefits Highlights
  
• 2022 Benefits Enrollment Guide
  
• 2022 Regional Medical Options Enrollment Guide
  
• 2022 Voluntary Benefits Guide
  
• 2022 Benefits Enrollment Guide for New Employees
  
• 2021 Benefits Highlights (HPN)
  
• 2021 Benefits Highlights
• 2021 Benefits Enrollment Guide (HPN)
  
• 2021 Benefits Enrollment Guide
  
• Guide to Your MetLife Voluntary Benefits (2021)
• 2021 Benefits Enrollment Guide for New Hires
  

• 2022 Retiree Benefits Guide
• 2022 Retiree Group Health Program Comparison Chart
  
• 2021 Retiree Benefits Guide
  
• 2021 Retiree Group Health Program Comparison Chart
• Important Considerations Regarding Medicare & RRD Coverage

INFORMACIÓN EN ESPAÑOL

• Puntos Principales de sus Beneficios de 2022
  
• 2022 Guía de los Beneficios de Inscripción
  
• 2022 Guía de Inscripción en las Opciones Medicas Regionales 
• 2022 Guía de Beneficios Voluntarios
• 2022 Guía de Inscripción en los Beneficios para Empleados Nuevos
  
• Guia HSA 2022
• Puntos Principales de sus Beneficios de 2021 (HPN)
  
• Puntos Principales de sus Beneficios de 2021
• 2021 Guía de los Beneficios de Inscripción (HPN)
  
• 2021 Guía de los Beneficios de Inscripción
• 2021 Guía de Inscripción en los Beneficios para Empleados Nuevos (HPN)
  
• 2021 Guía de Inscripción en los Beneficios para Empleados Nuevos
• Guia HSA 2021
• Ahorre Tiempo y Dinero al Surtir sus Recetas Médicas de Mantenimiento
• Cómo Aprovechar sus Beneficios al Máximo
• Su Aliado Médico ConsumerMedical
  
• Servicios de Cuidado de Visión
  
• Formulario de Reclamo de Atención Dental
  

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

• Group Health Program Booklet
  
• Group Health Program HPN Booklet
  
• Plan Administration Information Booklet
  

REGIONAL MEDICAL OPTIONS PROGRAM

• Blue Cross Blue Shield of IL HMO Booklet
  
• Dean Health HMO Booklet
  
• Kaiser California HMO Booklet
  
• Kaiser Oregon HMO Booklet 
• Plan Administration Information Booklet
  

SUPPLEMENTAL BENEFITS PROGRAM

• Supplemental Benefits Program Booklet
  
• Plan Administration Information Booklet
  

DENTAL BENEFIT PROGRAM

• Dental Benefit Program Booklet
• Plan Administration Information Booklet
  

VISION CARE PROGRAM

• Vision Care Program Booklet
  
• Plan Administration Information Booklet
  

HEALTH CARE FSA AND DEPENDENT DAY CARE FSA

• Flexible Spending Account Program Booklet
  

LIFE INSURANCE

• Life and Accident Insurance Program Booklet
• All Full-Time Employees Working in Puerto Rico
• All Full-Time Employees Excluding Employees Working in Puerto Rico
• Plan Administration Information Booklet
  

SHORT-TERM DISABILITY

• Short-Term Disability Program Booklet
  
• Plan Administration Information Booklet
  

LONG-TERM DISABILITY

• Long-Term Disability Program Booklet
• Plan Administration Information Booklet
  

SAVINGS

• Savings Plan SPD
  
• Savings Plan 5500

PENSION

All (with the exception of Puerto Rico)

• Pension Plan SPD - RR Donnelley - Part B - All Components
• Pension Plan 5500
  
• Annual Funding Notice
• Pension 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
  

SEPARATION PAY

• Separation Pay Plan SPD
  

RETIREE MEDICAL & LIFE INSURANCE

• Important Information if You Are Retiring on or after October 1, 2016

Retiree Medical

• Retiree Medical and Drug Benefit Program SPD
• 2020 Retiree Medical and Drug Benefit Program SM
• Medicare Advantage Plan Guide ‒ $400 Deductible
• Medicare Advantage Plan Guide ‒ $275 Deductible
• Medicare Advantage Plan Guide ‒ $200 Deductible
• Wellmark Certificate
• Wellmark Overview of Coverage
• Summary of Benefits for SilverScript Prescription Drug Plan (RR Donnelley/UHC)
• Opt-Out Notice for SilverScript Prescription Drug Plan
• Wellmark Health Insurance Brochure

2022 Summaries of Benefits & Coverage (SBCs)

ENGLISH

• HSA Value
  
• HSA Select
  
• HSA Advantage
  
• Copay Value
  
• Copay Select
  
• Copay Advantage
  
• Blue Advantage HMO
  
• BCBS McKay Plan
  
• Dean Health Plan Prevea 360
  
• Dean Health Plan HMO
  
• Kaiser HSA Plan (Atlanta)
  
• Kaiser HSA Plan (California)
  
• Kaiser HSA Plan (Colorado)
  
• Kaiser HSA Plan (Mid-Atlantic States)
  
• Kaiser HSA Plan (Oregon)
  
• Kaiser HSA Plan (Washington)
  
• Kaiser HMO Plan (Atlanta)
  
• Kaiser HMO Plan (California)
  
• Kaiser HMO Plan (Colorado)
  
• Kaiser HMO Plan (Mid-Atlantic States)
  
• Kaiser HMO Plan (Oregon)
  
• Kaiser HMO Plan (Washington)
  

2021 Summaries of Benefits & Coverage (SBCs)