Documents are in a PDF file format.
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
Tax Forms
Medical and Dental
- Medical Overview.pdf
- Live Health Online.pdf
- Pharmacy Overview.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
Life Insurance
Disability Insurance
- Disability Insurance.pdf
- Disability Conversion Information.pdf
- Disability Agent Contact Information.pdf
Discounts
Banking Information
- See Banking Discounts in the Discounts Section
Financial Information
- Direct Deposit Authorization Form.pdf
- Tax Sheltered Investment Program (403b).pdf
- Dependent Care Reimbursement Account (Pre-tax Childcare Expense).pdf
- Dependent Care Enrollment Form.pdf
- ADP Instructions
- Investment Resources.pdf
Student Loan Debt Information
- AAMC Debt Management Resource
- Public Service Loan Forgiveness Form.pdf
- GradFin Public Service Loan Forgiveness Program.pdf
- Citizens Student Lending Solutions
Counseling Programs
- Anthem Resource Advisor.pdf
- Anthem Psychology Online – licensed therapy at home.pdf
- Guardian Employee Assistance Program.pdf
Plan Documents
- Wrap Summary Plan Description.pdf
- Anthem Certificate of Coverage.pdf
- Section 125 Premium Conversion Plan.pdf
Insurance Benefits While Traveling
Work Related Injury – Workers’ Compensation
- Work Related Injury – Workers’ Compensation.pdf
- Purple Card Procedures.pdf
- Safety Committee Rosters.pdf
- Dental Residents and Fellows: Return completed forms to Jennifer Lindquist in the Dental Deans Office (AG009).
Exiting Residents
COBRA
- COBRA Election To Continue Benefits.pdf
- COBRA Notification Acknowledgement.pdf
- COBRA Coverage Rights.pdf
- COBRA Subsidy Request Form.pdf
- COBRA Notification of Subsidy Cancellation Form.pdf
COBRA ALTERNATIVES