Benefit Information

Welcome to the UACCB Human Resources Benefits Page.  You will find a Benefits Summary and Notice of Privacy Practices along with listings for: Superior Vision; Delta Dental; United Medical health; MedImpact prescription drug plan; Long Term Disability; Retirement information - specifically ATRS, APERS, TIAA-CREF, and VALIC; Life Insurance Plans;  Voluntary benefits, including Arkansas Federal Credit Union (AFCU), Long Term Care, MetLife Critical Illness; and Liberty Mutual Home and Auto insurance. Every effort is made to keep the posted benefit data current. Should you suspect errors or have specific questions, please do not hesitate to contact the HR Benefits Office at 870-612-2165 or email

Open Enrollment Fall 2015 for January 1, 2016

Notices Open Enrolllment Summary
2016 Health Plan Comparison Grid (revised 10.07.2015)
2016 Health Plan Deductibles and OOP Maximums
Notice regarding Dependent Eligibility
Dependent Audit Beginning 2016
Open Enrollment Signature Form 2016 Coverage
Note to Benefit Eligible Employees - Fall 2015 Open Enrollment Info.
FSA Enrollment Form 
Life and AD&D Change Form

Open Enrollment Fall 2014 for January 1, 2015

  1. Benefits Summary 2015
  2. Information, Comparison and Rates 2015
  3. 2015 Health Plan Comparison
  4. Superior Vision Benefits
  5. Summary of Prescription Changes for 2015
  6. Benefit Changes upon Marriage
  7. Tips for benefit use - Making the Most of your Health 2015
  8. Medicaid and Children's Health Insurance Program (CHIP)
  9. Spouse and Dependent Eligibility
  10. Dental Plan
  11. Retiree - Survivor Rates
  12. FSA Carryover - UAS
  13. FSA Eligible Expenses
  14. Medicare & Your UA Benefits 2015

2015 W4 Form

Family and Medical Leave Act - February 2013

Same Sex Marriage and UA Benefits Eligibility

Pre/Post Tax Election Form

Notice of Privacy Practices (HIPAA)

COBRA rates 2015


United Medical Resources

United Medical Resources Plan Comparison 2015

Glossary of Health Coverage and Medical Terms

Health Rates effective 7/1/2015

UA Health Plan SPD rev. 2015 and Health Benefit Plan Amendment - Care Management

Classic and POS In-Network
      $200 copay + $1000 Deductible + Coinsurance
POS Out-of-Network
      $200 copay + $2000 Deductibel + Coinsurance

Maternity Management

Adding your newborn to the UMR health plan

UMR Health Preauthorization Listing 2015

UMR Authorization for Release of Information form

Physician Attestation form (weight loss program)


UA Classic Summary Benefit Plan 2016
UA POS Summary Benefit Plan 2016

UA Classic Wellness Summary
UA POS Wellness Summary

UA Classic Summary Benefit Plan 2015 (effective July 2015)
UA POS Summary Benefit Plan 2015 (effective July 2015)

UA Classic Summary Benefit Plan 2015
UA POS Summary Benefit Plan 2015

UMR Health Brochures

UMR Diabetes Management
UMR Healthy Heart
UMR Nutritional Counseling
UMR Preventative Care Services - Women
UMR Preventative Care Services - Men and Children


Creditable Coverage Disclosure Notice

MedImpact Prescription Benefit Summary

MedImpact prescription Drug Formulary (January 2015)

UAS MedImpact Formulary Exception

Appeals Form

MedImpact Prescription Claim Form

Test Strips and Meters

MedVantx Mail Order Prescription Form

Delta Dental

Delta Dental Enrollment Application - add/drop/change

Choosing Your Dentist

Delta Dental Schedule of Benefits (effective January 1, 2012 - Current)

Delta Dental Benefit Plan Summary

Delta Dental Member User Guide

Superior Vision

Superior Vision Membership Claim Form

Superior Vision Member Guide - Using Your Vision Plan

Getting Started

Finding Network Providers

Superior Vision Benefit - Amendment

Superior Vision Enrollment Rules

FSA (Flexible Spending Plan)
FSA 2015 Information


Long Term Disability

Basic and Optional Long Term Disability Group Insurance (UNUM)

LTD Claim Form (UNUM)

  • LTD Amendment


Arkansas Teachers Retirement System (ATRS)

Arkansas Public Employees Retirement System (APERS)

University of Arkansas Retirement Plan - January 2014

University of Arkansas Retirement Plan 403(b) (old)

     UACCB 403(b) Agreement

Amendment to 403(b) - community colleges

Online Enrollment for TIAA-CREF

Valic Retirement

Medicare Advantage Information

Retirement Plan Contributions for Non-Benefits Eligible Employees
All employees on the university payroll (except student workers) are eligible to participate in an unmatched 403(B) on a voluntary basis.  If you are not in a benefits-eligible role you will not receive any employer contributions to your retirement plan, but you can make voluntary unmatched contributions.    You may select TIAA-CREF and/or VALIC for your retirement plan options.  Within the IRS limits, you may enroll, end, increase, decrease or suspend your contributions at any time.   Contact Human Resources for additional information or assistance.

Life Insurance

Standard Life Portability and Conversion

Voluntary Benefits

Arkansas Federal Credit Union Internet Branch

Long Term Care - The University of Arkansas benefits includes the offereing of a Long Term Care Plan.  Information, rates, and enrollment forms may be located at  The password to access the UA group information is UALTC.

MetLife Critical Illness - Outline of Coverage January 2015

Metlife Critical Illness Open Enrollment Fall 2014

Liberty Mutual Home and Auto
  Printable Liberty Mutual information sheet

Workers' Compensation

Incident Report Form

Company Nurse

Acknowledgement Form

Temporary Prescription Form