UAB Benefits

Forms and Handbooks

Life and Accidental Death/Dismemberment (AD&D) Insurance

 Sponsored Life and AD&D Plan (provided by UAB at no cost for eligible employees)

  Sponsored Life/AD&D Beneficiary Designation Form  
  Sponsored Life Summary  
  Sponsored Life/AD&D Certificate - COMING SOON  
     

Voluntary AD&D Plan

 
  Voluntary AD&D Enrollment/Beneficiary Designation Form  
  Voluntary AD&D Summary  
  Voluntary AD&D Certificate - COMING SOON  

Teacher's Retirement System of Alabama

Member Handbook (Tier 1)

  Member Handbook (Tier 2)  

Enrollment Form

Change of Beneficiary Form

Change of Address Form

DROP Program Handbook - Note: The DROP program ended for new participants effective March 24, 2011

Medical Dental and Vision Insurance

  Enrollment/Change Forms  
  2013  
  UAB Select Enrollment/Change Form  
     
  Booklets  
  2013 Plan Year  
  Viva UAB Summary Booklet  
  Viva UAB Certificate of Coverage - COMING SOON  
  Viva Access Summary Booklet  
  Viva Access Certificate of Coverage - COMING SOON  
  Blue Cross/Blue Shield Summary Booklet  
  Dental Summary- Basic  
  Dental Summary - Comprehensive  
  Basic Dental Plan Certificate - COMING SOON  
  Comprehensive Dental Plan Certificate - COMING SOON  
  VSP Vision Summary  
     
  2012 Plan Year  
  Viva UAB Summary Booklet  
  Viva UAB Certificate of Coverage  
  Viva Access Summary Booklet  
  Viva Access Certificate of Coverage  
  Blue Cross/Blue Shield Summary Booklet  
  Dental Summary- Basic  
  Dental Summary - Comprehensive  
  Basic Dental Plan Certificate  
  Comprehensive Dental Plan Certificate  
  VSP Vision Summary  
     

Flexible Spending Account (Healthcare & Dependent Daycare)

PayFlex

2013
FSA Summary
FSA Enrollment Form
FSA Election Change Form

Payflex Reimbursement Request Form

Payflex Direct Deposit Authorization

Tax Savings Calculator

Pay Flex Card

Web Instructions

  Mobile App  

Long -Term Disability

Certificate of Coverage