[UCRDBR] UCPath - Benefit eForm Migration to UCPath

[Departmental Benefits Representatives]

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October 25, 2021
To:
Department Benefits Representatives (DBRs)
From:
HR Benefits Office on behalf of the UCPath Center
Re:
UCPath - Benefit eForm Migration to UCPath
UCPath migrated the new Benefit eForm to UCPath production on Sunday, October 24, 2021.

The new eForm combines the following PDF forms into one eForm:


        *       Health Benefits Enrollment Form for Newly Eligible Employees (FR.008)<https://www.ucop.edu/ucpath-center/_files/mypath/new-forms/newly-eligible-employees.pdf>

        *       Health Benefits Enrollment Form for Life Events (FR.065)<https://www.ucop.edu/ucpath-center/_files/mypath/new-forms/health-benefits-enrollment-life-event.pdf>

        *       HSA, Life Insurance, Voluntary Disability and AD&D Change Form (FR.066)<https://www.ucop.edu/ucpath-center/_files/mypath/new-forms/hsa-life-ins-and-add-changes.pdf>

        *       Late Enrollment Request (FR.006)<https://www.ucop.edu/ucpath-center/_files/mypath/new-forms/late-enrollment-request.pdf>

This form can be utilized when self-service is not available. It will be accessible to all employees; however, it should only be utilized by employees who are eligible for the Faculty/Staff Benefit Programs.

Due to the focus on Open Enrollment activities, the new form will be available but not communicated to all employees until a later time. The current PDF forms referenced above will remain available in the Forms Library until the change from the PDF forms to the eForm is widely communicated.

Notes: Please advise employees that the eForm is not for Open Enrollment and cannot be used to make Open Enrollment elections.  It also cannot be used after Open Enrollment closes to request late election exceptions. These late election exceptions still need to be done via the paper form. Additionally, the new eForm is not applicable to Postdoctoral Scholar or Medical Resident benefits. The specific forms related to these benefit programs should continue to be utilized.

Training Materials

        *        Training materials are currently being developed and will be available for use on Friday, November 5, 2021.

For questions regarding the new eForms, please contact the UCPath Center at (855) 982-7284.

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