Plan Documents and Forms

2024–2025 Benefit Year Documents

Delta Dental Benefits Summary

Delta Dental Evidence of Coverage (EOC) [PDF]

VSP Evidence of Coverage (EOC) [PDF]

2024 Anthem HMO SBC [PDF]

2024 Anthem HMO SPD [PDF]

2024 Anthem HMO Medical Plan Benefits Summary [PDF]

2024 Anthem PPO SBC [PDF]

2024 Anthem PPO Medical Plan Benefits Summary [PDF]

2024 Anthem PPO SPD

2024 VSP Benefits Summary [PDF]

New York Life AD&D (Non-U.S. Citizen) Benefit Summary [PDF]

New York Life AD&D (U.S. Citizen) Benefit Summary [PDF]

New York Life Life Insurance (Non-U.S. Citizen) Benefit Summary [PDF]

New York Life Life Insurance (U.S. Citizen) Benefit Summary [PDF]

New York Life Long-Term Disability (Non-U.S. Citizen) Benefit Summary [PDF]

New York Life Long-Term Disability (U.S. Citizen) Benefit Summary [PDF]

New York Life Short-Term Disability (Non-U.S. Citizen) Benefit Summary [PDF]

New York Life Short-Term Disability (U.S. Citizen) Benefit Summary [PDF]

New York Life Short-Term Disability (U.S. Citizen) Evidence of Coverage [PDF]

New York Life Short-Term Disability (Non-U.S. Citizen) Evidence of Coverage [PDF]

New York Life Long-Term Disability (U.S. Citizen) Evidence of Coverage [PDF]

New York Life Long-Term Disability (Non-U.S. Citizen) Evidence of Coverage [PDF]

New York Life Life Insurance (U.S. Citizen) Evidence of Coverage [PDF]

New York Life Life Insurance (Non-U.S. Citizen) Evidence of Coverage [PDF]

New York Life Accident Insurance (U.S. Citizen) Evidence of Coverage [PDF]

New York Life Accident Insurance (Non-U.S. Citizen) Evidence of Coverage [PDF]

2023–2024 Benefit Year Documents

2024 FSA Summary Plan Description

2023 Anthem HMO Medical Plan Benefits Summary [PDF]

2023 Anthem HMO SBC [PDF]

2023 Anthem HMO SPD [PDF]

2023 Anthem PPO Medical Plan Benefits Summary [PDF]

2023 Anthem PPO SBC [PDF]

2023 Anthem PPO SPD [PDF]

2023 FSA Summary Plan Description [PDF]

2023 VSP Benefits Summary [PDF]

Family Forming

Carrot Elective Fertility Benefits

HRA Plan Document

HRA Summary Plan Description (SPD)

Fertility Plan Document

Adoption Plan Document

Surrogacy and Gestational Plan Document

Financial

New York Life Employee Assistance and Wellness Support

New York Life Survivor Assurance

New York Life Offerings Overview

Forms

2022 Long Term Disability Conversion Form

Delta Dental Claim Form

New York Life AD&D Beneficiary Form

New York Life AD&D Claim Form

New York Life Group Benefits Claim Form

New York Life How to File a Disability Claim Brochure

New York Life How to File a Life or AD&D Insurance Claim Brochure

New York Life Life Insurance Beneficiary Form

New York Life Life Insurance Claim Form

New York Life Long-Term Disability Claim Form

New York Life Short-Term Disability Claim Form