Forms & Plan Documents

Type

- Any -FormsNewslettersOther DocumentsPlan DocumentsRequired NoticesSummary of Annual Reports (SAR)Summary of Benefits and Coverage (SBC)Summary of Material Modification (SMM)Summary Plan Description (SPD)

Plan

- Any -DentalDisabilityFlexible Spending AccountsLife InsuranceMedicalOther Plans and ProgramsVision

Provider

- Any -AetnaAlightCignaCVS CaremarkHMO Blue—MassachusettsKaiser—CaliforniaMatrixMinnesota Life Insurance CompanyOptumOtherUnitedHealthcareVSPZurich

Forms

• Adoption Assistance Reimbursement Form
• Affidavit of Domestic Partnership
• Business Travel Accident Claim Form (Zurich)
• Business Travel Dismemberment Claim Form (Zurich)
• Cigna Global Health Benefits Claim Form
• Cigna Global Health Benefits-GU Health Payment Form (Australia)
• COVID-19 Related 401(k) Loan Repayment Suspension Form
• COVID-19 Related 401(k) Withdrawal Form
• Dependent Care Flexible Spending Account (FSA) Claim Form
• Evidence of Insurability Form
• Flu Shot Consent Form
• Flu Shot Consent Form—Mountain View only
• Health Care Flexible Spending Account (FSA) Claim Form
• Intuit Domestic Partner Benefit Program Certification of Legal Tax Dependents Affidavit
• MBA Claim Form
• Option to Port Term Life Insurance Coverage
• Securian Life Conversion Information
• Surrogacy Assistance Program Reimbursement Request Form

Newsletters

• April Newsletter
• February Newsletter
• January Newsletter
• March Newsletter

Other Documents

• 2021 Global Holiday Schedule
• 24 Hour Fitness Rates for employees in California (not Bay Area), Texas, Colorado, Florida, Oregon and Washington
• 24 Hour Fitness Rates for employees in the San Francisco Bay Area, New York, New Jersey, Maryland, Virginia and Hawaii
• 401(k) 2019 Plan Change Chart
• 401(k) Contribution Chart
• Aetna DMO Dental Plan
• ARAG Legal Plan Flyer
• Best Doctors FAQs
• Business Travelers Accident (BTA) Customer Agreement ID Theft
• Business Travelers Accident (BTA) Insurance Identity Theft Brochure
• Business Travelers Accident Secure Travel Wallet Card
• CARES Act FAQs
• Cigna Choice Fund HSA Creditable Coverage MA Rider
• Cigna Envoy Registration Guide
• Cigna Global Health Advantage Benefits at a Glance
• Cigna Global Health Benefits ID Card
• Cigna Global Health Benefits Welcome Kit
• Cigna Global Health Benefits-CignaLinks Australia
• Cigna Global Health Benefits-CignaLinks Canada
• Cigna Global Health Benefits-CignaLinks UK
• Cigna Global Health Benefits–Transition of Care
• Cigna Global Health Benefits–Understanding your Explanation of Benefits
• Cigna Managed Network Plan Creditable Coverage MA Rider
• Cigna Telehealth
• COVID-19 Educational Resources
• COVID-19 Mindfulness Support
• COVID-19 Stress Management
• Crossover Health Fee Schedule
• Crossover Membership Overview
• CVS Caremark Advanced Control Formulary
• Dependent Verification Required Documents
• Disability Insurance Plan Comparison Chart
• Empower Think Twice
• ESPP Enrollment Guide for E*Trade
• ESPP Trading Schedule
• February 23 Benefits Team Office Hours: Mental Health for Children
• Financial Knowledge Tax-Planning Strategies
• Financial Knowledge Understanding the ESPP
• FY 2021 AE What's Changing
• FY 2021 Plan Snapshot
• Global Phone Numbers
• Health Care Reform Eligibility
• How Identity Theft Affects You
• How to Liquidate Investments
• HSA/FSA Overview
• HSA: Customer Identification Process (CIP) Overview
• Insider Trading Policy
• LGBTQ Benefits Overview
• Manager Guide: Preventing Burnout—Optimizing Time & Energy
• Manager Guide: Supporting Team Members' Well-Being
• March 2 Benefits Team Office Hours: Child Care and Learning Support
• Medicare Coordination of Benefits
• Mindfulness Team Playbook
• MyCommuter Mobile App User Guide
• OPC Charities and Prizes
• Optum EAP and WorkLife Services Benefit
• Optum Remote Well-Being Toolkit Issue 1
• Optum Remote Well-Being Toolkit Issue 2
• Optum Remote Well-Being Toolkit Issue 3
• Optum Remote Well-Being Toolkit Issue 4
• Redpoint Travel Assistance FAQ
• Rethink 10 Tips for Supporting Your Kids Right Now
• Retirement Distributions Options
• SDI/VDI Comparison Chart 2021
• Total Rewards Summary
• Virgin Pulse Activity Tracker Device Form
• Virgin Pulse U.S. Brochure

Plan Documents

• AD&D Certificate of Insurance
• Aetna Dental DMO Plan Summary of Benefits
• Aetna PPO Dental Plan Schedule of Benefits
• Aetna PPO Dental Plan Schedule of Benefits for Nevada residents only
• Aetna PPO Dental Plan Summary of Benefits
• Aetna PPO Dental Plan Summary of Benefits for Nevada residents only
• Cigna International Certificate of Insurance
• Cigna International Policy
• Cigna International Pre-Departure Medical Assessment
• Cigna Transgender Benefits
• Cigna Transition of Care
• CVS Caremark coverage for Cigna Choice Fund HSA—FY 2021
• CVS Caremark coverage for Cigna Managed Network Plan—FY 2020
• CVS Caremark coverage for UHC Network Plan—FY 2020
• ESPP Prospectus
• Group Term Life Certificate of Insurance
• Intuit Group Term Life and AD&D Insurance
• Intuit Inc. Consolidated Welfare Plan
• Intuit Inc. Consolidated Welfare Plan Amendment
• Intuit Inc. Flexible Benefit Plan
• Intuit Inc. Flexible Benefit Plan Amendment
• Kaiser Permanente: Get the Right Care for You
• Kaiser Transgender Benefits
• Life Insurance Benefits and Costs
• UHC Transgender Benefits
• UHC Transition of Care
• VSP Evidence of Coverage
• VSP Policy
• Zurich Travel Assist Summary

Required Notices

• Cal-COBRA Notice
• CHIP Notice 2020
• Genetic Information Nondiscrimination Act Notice
• Health Insurance Marketplace Notice
• HIPAA Amendment to Consolidated Welfare Benefit Plan
• HIPAA Privacy Notice
• Newborns' and Mothers' Health Protection Act Notice
• Notice of Special Enrollment Periods
• Summary Annual Report for Consolidated Welfare Plan FY 2019
• Wellness Program EEOC Notice
• Women’s Health and Cancer Rights Act Required Annual Notice

Summary of Annual Reports (SAR)

• 401(k) Summary Annual Report

Summary of Benefits and Coverage (SBC)

• Cigna Choice Fund HSA Summary of Benefits and Coverage (SBC)—FY 2021
• Cigna Managed Network Plan Summary of Benefits and Coverage (SBC)—FY 2021
• Cigna SelectTime Managed Network Plan Summary of Benefits and Coverage (SBC)—FY 2021
• Kaiser Permanente Hawaii Plan Summary of Benefits and Coverage (SBC)—FY 2021
• Kaiser Permanente Northern California Summary of Benefits and Coverage (SBC)—FY 2021
• Kaiser Permanente Southern California Summary of Benefits and Coverage (SBC)—FY 2021
• UHC Harvard Pilgrim Summary of Benefits and Coverage (SBC)—FY 2021
• UHC Network Plan Summary of Benefits and Coverage (SBC)—FY 2021

Summary Plan Description (SPD)

• 401(k) Summary Plan Description
• Cigna Choice Fund HSA Summary Plan Description (SPD)—FY 2021
• Cigna Managed Network Plan Summary Plan Description (SPD)—FY 2021
• Kaiser Chiropractic Services Amendment Evidence of Coverage–FY 2020
• Kaiser Permanente Traditional HMO Plan Evidence of Coverage–FY 2020
• Summary of Material Modifications (SMM) for the Intuit Consolidated Welfare Plan–FY 2021
• UHC Network/Harvard Pilgrim Network Summary Plan Description (SPD)—FY 2021

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