Uniform Summary of Benefits and Coverage

Legal Notices

You have the right to obtain a printed copy free of charge of any or all of these notices at any time by contacting the Office of Employee Benefits at benefits@utsystem.edu or 512-499-4616.

IMPORTANT IF YOU (AND/OR YOUR DEPENDENTS) HAVE MEDICARE OR WILL BECOME ELIGIBLE FOR MEDICARE IN THE NEXT 12 MONTHS, A FEDERAL LAW GIVES YOU MORE CHOICES ABOUT YOUR PRESCRIPTION DRUG COVERAGE. PLEASE SEE THE MEDICARE PART D NOTICE FOR MORE DETAILS.

The uniform Summary of Benefits and Coverage (SBC) provision of the Affordable Care Act requires all insurers and group health plans to provide consumers with an SBC to describe key plan features in a mandated format, including limitations and exclusions. The provision also requires that consumers have access to a uniform glossary of terms commonly used in health care coverage. The UT insurance SBCs are available online. UT SELECT PPO or Out-of-Area coverage: www.bcbstx. com/ut/coverage UT CONNECT coverage: www.bcbstx.com/utconnect/coverage You can view the glossary at www.utsystem.edu/documents/docs/publication/2018/glossary- health-coverage-andmedical-terms

To request a copy of these documents free of charge, you may call the SBC Hotline at 1-855-756-4448.