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<h1><img width="192" height="73" id="Picture_x0020_1" src="cid:image001.png@01D827C6.A8EA87E0"></h1>
<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif">February 22, 2022<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:0in;margin-bottom:.0001pt;line-height:normal">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
</td>
</tr>
<tr>
<td width="78" valign="top" style="width:58.5pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">To:<o:p></o:p></span></p>
</td>
<td width="546" valign="top" style="width:409.5pt;padding:0in 0in 0in 0in">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">Department Benefit Representatives<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td width="78" valign="top" style="width:58.5pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">From:<o:p></o:p></span></p>
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<td width="546" valign="top" style="width:409.5pt;padding:0in 0in 0in 0in">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">HR Benefits Office on behalf of UC Office of the President<o:p></o:p></span></p>
</td>
</tr>
<tr>
<td width="78" valign="top" style="width:58.5pt;padding:0in 5.4pt 0in 5.4pt">
<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
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<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;text-align:justify;line-height:110%">
<span style="font-family:"Arial",sans-serif">UCPath Benefits eForms Availability<o:p></o:p></span></p>
</td>
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<td width="624" colspan="2" valign="top" style="width:6.5in;padding:0in 5.4pt 0in 5.4pt">
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<span style="font-family:"Arial",sans-serif">The UCPath Center has streamlined their processes for submitting health and welfare change forms by introducing the Benefits eForms. Using Benefits eForms makes it easier to access and understand the process to make
plan changes.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:-.7pt;margin-bottom:.0001pt;line-height:110%">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:-.7pt;margin-bottom:.0001pt;line-height:110%">
<b><span style="font-family:"Arial",sans-serif;color:#002060">Did you know</span></b><span style="font-family:"Arial",sans-serif">: You are not required to submit a UCPath inquiry via the
<i>Ask UCPath</i> icon when using Benefits eForms.<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:-.7pt;margin-bottom:.0001pt;line-height:110%">
<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoListParagraphCxSpFirst" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:6.0pt;margin-left:26.0pt;mso-add-space:auto;text-indent:-.25in;line-height:110%;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">The new Benefits eForm is used to submit enrollment information directly into the UCPath portal eliminating the need to create a case inquiry.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:26.0pt;margin-bottom:.0001pt;mso-add-space:auto;text-indent:-.25in;line-height:110%;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">The following forms have been updated and moved to the Forms Library on UCPath under the Benefits eForm link.
<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:44.0pt;margin-bottom:.0001pt;mso-add-space:auto;text-indent:-.25in;line-height:110%;mso-list:l2 level1 lfo2">
<![if !supportLists]><span style="font-family:"Courier New";color:#002060"><span style="mso-list:Ignore">o<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Health Benefits Enrollment Form for Newly Eligible Employees (FR.008)<o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:"Courier New";color:#002060"><span style="mso-list:Ignore">o<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Health Benefits Enrollment Form for Life Events (FR.065)<o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:"Courier New";color:#002060"><span style="mso-list:Ignore">o<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">HSA, Life Insurance, Voluntary Disability and AD&D Change Form (FR.066)<o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:"Courier New";color:#002060"><span style="mso-list:Ignore">o<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Late Enrollment Request (FR.006)
<o:p></o:p></span></p>
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<span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
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<b><span style="font-family:"Arial",sans-serif">Training Resources<o:p></o:p></span></b></p>
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<span style="font-family:"Arial",sans-serif">The following training materials have also been provided to assist with completing the forms and explaining the required information.<o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Benefits eForms:
<a href="https://sp.ucop.edu/sites/ucpathhelp/SelfServiceUsers/PORplayer/index.html?Guid=75516434-ed49-44d0-a71f-8c5d2a27b18f&bypasstoc=0">
Submit Form for Newly Eligible-New Hire</a><o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Benefits eForms:
<a href="https://spsts.ucop.edu/Picker.aspx?ReturnUrl=%2fdefault.aspx%3fwa%3dwsignin1.0%26wtrealm%3dhttps%253a%252f%252fsp.ucop.edu%252f_trust%252f%26wctx%3dhttps%253a%252f%252fsp.ucop.edu%252fsites%252fucpathhelp%252f_layouts%252f15%252fAuthenticate.aspx%253fSource%253d%25252Fsites%25252Fucpathhelp%25252FSelfServiceUsers%25252FPORplayer%25252Findex%25252Ehtml%25253FGuid%25253D788d1c48%25252D426e%25252D4b61%25252D9331%25252D1b821fc757e1%252526bypasstoc%25253D0%26wreply%3dhttps%253a%252f%252fsp.ucop.edu%252f_trust%252fdefault.aspx&wa=wsignin1.0&wtrealm=https%3a%2f%2fsp.ucop.edu%2f_trust%2f&wctx=https%3a%2f%2fsp.ucop.edu%2fsites%2fucpathhelp%2f_layouts%2f15%2fAuthenticate.aspx%3fSource%3d%252Fsites%252Fucpathhelp%252FSelfServiceUsers%252FPORplayer%252Findex%252Ehtml%253FGuid%253D788d1c48%252D426e%252D4b61%252D9331%252D1b821fc757e1%2526bypasstoc%253D0&wreply=https%3a%2f%2fsp.ucop.edu%2f_trust%2fdefault.aspx">
Submit Form for Life Event-Late Enrollment</a><o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Benefits eForms:
<a href="https://spsts.ucop.edu/Picker.aspx?ReturnUrl=%2fdefault.aspx%3fwa%3dwsignin1.0%26wtrealm%3dhttps%253a%252f%252fsp.ucop.edu%252f_trust%252f%26wctx%3dhttps%253a%252f%252fsp.ucop.edu%252fsites%252fucpathhelp%252f_layouts%252f15%252fAuthenticate.aspx%253fSource%253d%25252Fsites%25252Fucpathhelp%25252FSelfServiceUsers%25252FPORplayer%25252Findex%25252Ehtml%25253FGuid%25253Db5255355%25252De8a0%25252D4578%25252Da556%25252D051663818593%252526bypasstoc%25253D0%26wreply%3dhttps%253a%252f%252fsp.ucop.edu%252f_trust%252fdefault.aspx&wa=wsignin1.0&wtrealm=https%3a%2f%2fsp.ucop.edu%2f_trust%2f&wctx=https%3a%2f%2fsp.ucop.edu%2fsites%2fucpathhelp%2f_layouts%2f15%2fAuthenticate.aspx%3fSource%3d%252Fsites%252Fucpathhelp%252FSelfServiceUsers%252FPORplayer%252Findex%252Ehtml%253FGuid%253Db5255355%252De8a0%252D4578%252Da556%252D051663818593%2526bypasstoc%253D0&wreply=https%3a%2f%2fsp.ucop.edu%2f_trust%2fdefault.aspx">
Submit Form to Change AD&D Enrollment</a><o:p></o:p></span></p>
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<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Benefits eForms:
<a href="https://spsts.ucop.edu/Picker.aspx?ReturnUrl=%2fdefault.aspx%3fwa%3dwsignin1.0%26wtrealm%3dhttps%253a%252f%252fsp.ucop.edu%252f_trust%252f%26wctx%3dhttps%253a%252f%252fsp.ucop.edu%252fsites%252fucpathhelp%252f_layouts%252f15%252fAuthenticate.aspx%253fSource%253d%25252Fsites%25252Fucpathhelp%25252FSelfServiceUsers%25252FPORplayer%25252Findex%25252Ehtml%25253FGuid%25253Dedb4e09d%25252Df9d6%25252D4388%25252Dbf17%25252D5f226af33df4%252526bypasstoc%25253D0%26wreply%3dhttps%253a%252f%252fsp.ucop.edu%252f_trust%252fdefault.aspx&wa=wsignin1.0&wtrealm=https%3a%2f%2fsp.ucop.edu%2f_trust%2f&wctx=https%3a%2f%2fsp.ucop.edu%2fsites%2fucpathhelp%2f_layouts%2f15%2fAuthenticate.aspx%3fSource%3d%252Fsites%252Fucpathhelp%252FSelfServiceUsers%252FPORplayer%252Findex%252Ehtml%253FGuid%253Dedb4e09d%252Df9d6%252D4388%252Dbf17%252D5f226af33df4%2526bypasstoc%253D0&wreply=https%3a%2f%2fsp.ucop.edu%2f_trust%2fdefault.aspx">
Submit Form to Change HSA Enrollment</a><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:26.0pt;margin-bottom:.0001pt;mso-add-space:auto;text-indent:-.25in;line-height:110%;mso-list:l1 level1 lfo3">
<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Benefits eForms:
<a href="https://sp.ucop.edu/sites/ucpathhelp/SelfServiceUsers/PORplayer/data/toc.html?treeindex=82&Guid=6b4fdc4a-ed23-4528-86eb-d7612bbdcec5&bypasstoc=0">
Submit Form to Change Life Insurance Enrollment</a><o:p></o:p></span></p>
<p class="MsoListParagraphCxSpLast" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:0in;margin-left:26.0pt;margin-bottom:.0001pt;mso-add-space:auto;text-indent:-.25in;line-height:110%;mso-list:l1 level1 lfo3">
<![if !supportLists]><span style="font-family:Symbol;color:#002060"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-family:"Arial",sans-serif">Benefits eForms:
<a href="https://sp.ucop.edu/sites/ucpathhelp/SelfServiceUsers/PORplayer/data/toc.html?treeindex=83&Guid=71f88e8a-9080-4e9a-846f-580b1814b1d1&bypasstoc=0">
Submit Form to Change Voluntary Disability Enrollment</a> <o:p></o:p></span></p>
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