Forms & Documents
Last Updated November 4, 2024
MY HEALTH
- BCBSIL Medical Claim Form
- CVS/caremark Prescription Reimbursement Claim Form
- Letter to Physician
- Prescription Drug Maintenance Medication Program
- Dental Claim Form – English
- Cigna Dental Benefit Summary DPPO
- Cigna Dental Benefit Summary DPPO Texas
- Cigna Dental Benefit Summary DPPO Plus
- Cigna Dental Benefit Summary DPPO Plus Texas
- EyeMed Essential Vision Benefit Summary
- EyeMed Enhanced Vision Benefit Summary
- Hearing Discount Member Flyer
MY MONEY
LIFE CHANGES
NEW HIRES AND ANNUAL ENROLLMENT
- 2025 Benefits Enrollment Guide for New Employees
- 2024 Benefits Highlights
- 2024 Benefits Enrollment Guide
- 2024 Regional Medical Options Enrollment Guide
- 2024 Supplemental & Voluntary Benefits Guide
- Frequently Asked Questions
- 2024 Benefits Enrollment Guide for New Employees
RETIREES
- 2024 Retiree Benefits Guide
- 2024 Retiree Group Health Program Comparison Chart
- Important Considerations Regarding Medicare & RRD Coverage
INFORMACIÓN EN ESPAÑOL
- Guía de Inscripción de Empleados Nuevos en 2025
- Guía de Inscripción en los Beneficios de 2024
- Guía de Opciones Médicas Regionales de 2024
- Maneras de Ahorrar y Pagar su Atención
- Guía de Beneficios Voluntarios
- Bienvenido a 65: Lo Que Necesita Saber Sobre Sus Beneficios
- Preguntas Frecuentes
- Guía de Inscripción de Empleados Nuevos en 2024
- Ahorre Tiempo y Dinero al Surtir sus Recetas Médicas de Mantenimiento
- Cómo Aprovechar sus Beneficios al Máximo
- Servicios de Cuidado de Visión
- Formulario de Reclamo de Atención Dental
- Recursos de Salud Mental
LEGAL NOTICES
SUMMARY PLAN DESCRIPTIONS (SPDs)
- Key Provisions: COVID-19 & Your RRD Benefits SMM
- 2020 SMM for the RRD Flexible Benefits Plan & RRD Group Benefits Plan re: COVID-19 Suspension of Deadlines
- 2020 SMM for the RRD Flexible Benefits Plan
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 HMO Booklet
- Dean Prevea HMO Booklet
- Kaiser Georgia HMO with HSA Booklet
- Kaiser Northern California HMO with HSA Booklet
- Kaiser Southern California HMO with HSA Booklet
- Kaiser Colorado HMO with HSA Booklet
- Kaiser Mid-Atlantic HMO with HSA Booklet
- Kaiser Oregon HMO with HSA Booklet
- Kaiser Washington HMO with HSA Booklet (Employee Only)
- Kaiser Washington HMO with HSA Booklet (Family)
- Plan Administration Information Booklet
SUPPLEMENTAL BENEFITS PROGRAM
- Critical Illness Certificate Rider
- Supplemental Benefits Program Booklet
- Plan Administration Information Booklet
DENTAL BENEFIT PROGRAM
VISION CARE PROGRAM
HEALTH CARE FSA AND DEPENDENT DAY CARE FSA
EMPLOYEE ASSISTANCE PROGRAM (EAP)
LIFE INSURANCE
SHORT-TERM DISABILITY
LONG-TERM DISABILITY
SAVINGS
- SMM — RR Donnelley Savings Plan
- Savings Plan Summary Sheet — 401(k) Matching Contributions
- 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
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
Banta Salaried
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.
Cardinal Brands
Check Printers
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
RETIREE MEDICAL & LIFE INSURANCE
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
2025 Summaries of Benefits & Coverage (SBCs)
- HSA Value
- HSA Advantage
- Copay Advantage
- Coupe PPO
- Dean Health Plan Prevea 360
- Dean Health Plan HMO
- Kaiser HSA Plan (Mid-Atlantic States)
- Kaiser HSA Plan (Northern California)
- Kaiser HSA Plan (Southern California)
- Kaiser HSA Plan (Oregon)
- Kaiser HSA Plan (Washington)
2024 Summaries of Benefits & Coverage (SBCs)
- HSA Value
- HSA Advantage
- Copay Value
- Copay Advantage
- Blue Advantage HMO
- BCBS McKay Plan
- Dean Health Plan Prevea 360
- Dean Health Plan HMO
- Kaiser HSA Plan (Atlanta)
- Kaiser HSA Plan (Northern California)
- Kaiser HSA Plan (Southern California)
- Kaiser HSA Plan (Colorado)
- Kaiser HSA Plan (Mid-Atlantic States)
- Kaiser HSA Plan (Oregon)
- Kaiser HSA Plan (Washington)