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<p class="MsoNormal"><span style="font-family:"Arial",sans-serif;mso-ligatures:none"><img width="612" height="245" id="_x0000_i1025" src="cid:image001.jpg@01DA0B3A.714077B0"></span><span style="font-family:"Arial",sans-serif"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">October 30, 2023<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
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<span style="line-height:110%;font-family:"Arial",sans-serif">To:</span><span style="font-size:12.0pt;line-height:110%;font-family:"Arial",sans-serif"><o:p></o:p></span></p>
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<td width="643" colspan="2" valign="top" style="width:482.5pt;padding:0in 0in 0in 0in;height:28.85pt">
<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="line-height:110%;font-family:"Arial",sans-serif">Department Benefits Representatives<o:p></o:p></span></p>
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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="line-height:110%;font-family:"Arial",sans-serif">From:</span><span style="font-size:12.0pt;line-height:110%;font-family:"Arial",sans-serif"><o:p></o:p></span></p>
</td>
<td width="643" colspan="2" valign="top" style="width:482.5pt;padding:0in 0in 0in 0in;height:28.85pt">
<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="line-height:110%;font-family:"Arial",sans-serif">Central HR Benefits Office on behalf of the UCPath Center<o:p></o:p></span></p>
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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="line-height:110%;font-family:"Arial",sans-serif">Re:</span><span style="font-size:11.5pt;line-height:110%;font-family:"Arial",sans-serif"><o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:6.0pt;margin-left:-.7pt;line-height:110%">
<b><span style="line-height:110%;font-family:"Arial",sans-serif;color:black;mso-ligatures:none">UCPath - Supplemental Health Plan</span></b><b><span style="line-height:110%;font-family:"Arial",sans-serif;mso-ligatures:none">s<span style="color:black"> End-of-Year
Enrollment Process </span></span></b><b><span style="font-size:12.0pt;line-height:110%"><o:p></o:p></span></b></p>
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<p class="MsoNormal">_____________________________________________________________________________________________________<o:p></o:p></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif">DBRs, please share this important information via your department listserv.<o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:14.0pt;font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Due to the plan provider change from Aflac to Prudential effective January 1, 2024, special procedures are necessary for 2023 Supplemental Health Plan enrollments occurring from November 1, 2023,
until the end of the 2023 plan (December 31, 2023). <o:p></o:p></span></p>
<p class="MsoNormal"><b><u><span style="font-family:"Arial",sans-serif"><o:p><span style="text-decoration:none"> </span></o:p></span></u></b></p>
<p class="MsoNormal" style="margin-bottom:14.0pt;line-height:105%"><b><u><span style="font-family:"Arial",sans-serif">Supplemental Health Plans (SHP)
</span></u></b><span style="font-family:"Arial",sans-serif"><o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:8.0pt;line-height:105%"><span style="font-family:"Arial",sans-serif">Newly-eligible employees hired from November 1 to December 31, 2023, and eligible employees experiencing a qualifying life event during this time,
who wish to enroll in or change elections in Hospital Indemnity, Accident and/or Critical Illness Insurance for the 2023 plan year, will need to complete a Benefits eForm before the end of their 31-day Period of Initial Eligibility (PIE). These plans will
not be available for elections through the UCPath Self-Service from November 1 through December 31, 2023. <o:p></o:p></span></p>
<p class="MsoNormal" style="margin-left:9.35pt"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Supplemental Health Plan enrollments are effective as of the date of hire, the date of new eligibility, or the life event date. Coverage will continue to the following plan year; therefore, if
an employee enrolls for 2023 and would like to waive or make changes effective January 1, 2024, they will need to make Open Enrollment elections via UCPath online.</span><br>
<br>
<span style="font-family:"Arial",sans-serif">The deadline for the 2023 plan year enrollments in the Supplemental Health Plans, regardless of effective date, is Friday, December 8, 2023, at 5:00 PM, Pacific Time.
<o:p></o:p></span></p>
<p class="MsoNormal"><br>
<span style="font-family:"Arial",sans-serif">After the deadline, all SHP enrollment requests must be submitted via a Benefits eForm before the end of their 31-day PIE, or at any time if the request is to waive or reduce coverage. These enrollments/changes will
be effective January 1, 2024.<o:p></o:p></span></p>
<p class="MsoNormal"><b><u><span style="font-family:"Arial",sans-serif"><o:p><span style="text-decoration:none"> </span></o:p></span></u></b></p>
<p class="MsoNormal"><b><u><span style="font-family:"Arial",sans-serif">How to make SHP elections/updates after November 1, 2023</span></u></b><br>
<br>
<b><u><span style="font-family:"Arial",sans-serif">1) Benefits eForm<o:p></o:p></span></u></b></p>
<p class="MsoListParagraphCxSpFirst" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Employee can access the eForm through the UCPath system at
</span><span style="font-size:11.0pt"><a href="http://ucpath.universityofcalifornia.edu/"><span style="font-family:"Arial",sans-serif">http://ucpath.universityofcalifornia.edu</span></a></span><span style="font-size:11.0pt;font-family:"Arial",sans-serif"> by
following the steps below:<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Select the
<b>Forms Library</b> on the menu to the left of the UCPath Dashboard<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Select
<b>Access Forms</b>. User will be automatically redirected to the Forms Library page.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Under the corresponding Benefit category section, click on
<b>Benefits eForms: Submit New Form<o:p></o:p></b></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Elect the employment category under the
<b>Employee Benefit Category</b> section.<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Click the
<b>Reason for Request</b> drop-down menu and choose the corresponding request reason (e.g., Newly Eligible, Qualifying Life Event)<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">In the section titled “Please Explain Why You Are Using This Form” enter the following:<b><i> 2023 Supplemental Health Plan Enrollment(s)<o:p></o:p></i></b></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Navigate through the form to add new dependent(s) and make enrollment updates.
<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Agree to the Terms and Conditions and the signature acknowledgement.
<o:p></o:p></span></p>
<p class="MsoListParagraphCxSpMiddle" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">Once user is ready for UCPath to process their form,
<b>click the Submit button.<o:p></o:p></b></span></p>
<p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;mso-list:l0 level1 lfo1">
<![if !supportLists]><span style="font-size:11.0pt;font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:11.0pt;font-family:"Arial",sans-serif">View the confirmation of submission message<o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><span style="font-family:"Arial",sans-serif">OR</span></b><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><b><u><span style="font-family:"Arial",sans-serif">2) Submit PDF Enrollment Form</span></u></b><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">If an employee is unable to access UCPath Online to submit a Benefits eForm, the employee or a benefits professional can request the PDF version of the corresponding enrollment forms be sent
to them by visiting </span><a href="http://ucpath.universityofcalifornia.edu/"><b><span style="font-family:"Arial",sans-serif;color:windowtext">UCPath</span></b><span style="font-family:"Arial",sans-serif;color:windowtext">
</span></a><span style="font-family:"Arial",sans-serif">(www.ucpath.universityofcalifornia.edu) and clicking on “<b>Ask UCPath</b>” to submit an inquiry or by calling UCPath and requesting the PDF Form. Following is how employees can reach the UCPath Center:
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="font-family:"Arial",sans-serif;color:black">Phone Number:</span></b><span style="font-family:"Arial",sans-serif;color:black"> 1-855-982-7284<br>
<b>Hours of Operation:</b> Monday to Friday, from 8:00 AM until 5:00 PM, Pacific Time<o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family:"Arial",sans-serif;color:black">Secure Fax Number:
</span></b><span style="font-family:"Arial",sans-serif;color:black">1-855-982-2329<b>
</b><br>
<b>Mailing Address:</b> 14350-1 Meridian Parkway, Riverside, CA 92518<br>
<b>Email Address:</b> <a href="mailto:ucpath@universityofcalifornia.edu"><span style="color:blue">ucpath@universityofcalifornia.edu</span></a><br>
<b>Website Address:</b> ucpath.universityofcalifornia.edu </span><span style="font-family:"Arial",sans-serif"><o:p></o:p></span></p>
<p class="MsoNormal"><br>
<span style="font-family:"Arial",sans-serif">A SHP 2023 End-of-Year Enrollment inquiry should include the following details:</span><br>
<br>
<span style="font-family:"Arial",sans-serif">Topic: Benefits</span><br>
<span style="font-family:"Arial",sans-serif">Category: <b>Submit Form</b> (select either
<b>Newly Eligible</b> or <b>Life Event</b>)</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Arial",sans-serif">Subject:
<b>2023 Supplemental Health Plan Enrollment(s)<o:p></o:p></b></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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