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School of Dental Medicine:

Dental School Contacts

• Employment Questions

John Brigada
Director of Finance & Administration
Office: 860-679-4065
E-mail: jbrigada@uchc.edu

• Program Questions

Eric R. Bernstein, J.D., Ed.D.
Interim Associate Dean for Academic Affairs
Office: 860-679-2672
E-mail: erbernstein@uchc.edu

Frequently Asked Questions

Whistleblower Policy.pdf

Tax Forms

• W-4 Instructions.pdf
• W-4 Form.pdf
• CT W-4 Instructions.pdf
• CT W-4 Form.pdf

Medical and Dental

• Medical Overview.pdf
• Live Health Online.pdf
• Pharmacy Overview.pdf
  • Home Delivery Order Form.pdf
• Dental Overview.pdf
• Medical/Dental Benefit Booklet and Summary of Benefits and Coverage.pdf
• 2020 Benefits Notices Booklet.pdf
• Enrollment Application.pdf
• Medical/Dental Waiver Form.pdf
• Find an In Network Provider.pdf
• Out of Network Claim Form.pdf

Vision

• Overview.pdf
• Application.pdf
• Blue View Waiver Form.pdf

Life Insurance

• Benefits Summary.pdf
• Policy Certificate.pdf
• Life Insurance Change of Beneficiary Form.pdf

Disability Insurance

• Disability Insurance.pdf
• Disability Agent Contact Information.pdf

Malpractice.pdf

Discounts

• Go here to view discounts available to employees

Banking Information

• See Banking Discounts in the Discounts Section

Financial Information

• Direct Deposit Authorization Form.pdf
• Tax Sheltered Investment Program (403b).pdf
  • 403(b) Enrollment Form.pdf
• Dependent Care Reimbursement Account (Pre-tax Childcare Expense).pdf
• Dependent Care Enrollment Form.pdf
• ADP Instructions
  • Request Paperless Statements.pdf
  • Register with ADP.pdf
• Investment Resources.pdf

Student Loan Debt Information

• AAMC Debt Management Resource
• Public Service Loan Forgiveness Form.pdf
• The Institute of Student Loan Advisors Corporation (TISLA)
• GradFin Public Service Loan Forgiveness Program.pdf
• Citizens Student Lending Solutions

Counseling Programs

• Anthem Psychology Online – licensed therapy at home.pdf
• Guardian Employee Assistance Program.pdf
• Stressed Resident Confidential Counseling.pdf

Plan Documents

• Wrap Summary Plan Description.pdf
• Anthem Certificate of Coverage.pdf
• Section 125 Premium Conversion Plan.pdf

Insurance Benefits While Traveling

• Anthem International Travel.pdf
• Blue Card Claim Form.pdf
• Travel Assistance.pdf

Work Related Injury – Workers’ Compensation

• Work Related Injury – Workers’ Compensation.pdf
• Purple Card Procedures.pdf
• Safety Committee Rosters.pdf

Wellness Center

• Dental Residents and Fellows: Return completed forms to Jennifer Lindquist in the Dental Deans Office (AG009).

Exiting Residents

• Exiting Instructions.pdf
• Payroll Forwarding Address.pdf
• Disability Conversion Information.pdf

COBRA

• COBRA Election To Continue Benefits.pdf
• COBRA Notification Acknowledgement.pdf
• COBRA Coverage Rights.pdf

COBRA ALTERNATIVES

• Health Insurance Exchanges.pdf