Plan documents and forms

Health and wellbeing

Global Aetna International Booklet & Schedule of Benefits (Medical Dental Vision Life) [PDF]
Global Aetna International Medical Claim Form [PDF]
Global Aetna WorldTraveler Benefits Summary 2024 [PDF]
Global Aetna WorldTraveler Medical Plan Booklet 2024 [PDF]
Global Wellbeing Reimbursement Program 2024 [PDF]
US AccessHope Program Summary [PDF]
US Adobe Wrap Around SPD [PDF]
US Aetna Employee Assistance Program (EAP) Evidence of Coverage and Disclosure [PDF]
US Aetna Medical Claim Form [PDF]
US Aetna Prescription Drug Claim Form [PDF]
US Aetna Prescription Drug Home Delivery Claim Form [PDF]
US Aetna Specialty Prescription Drug Claim Form [PDF]
US Aetna Transition of Care Request Form [PDF]
US Executive Health Program 2022 [PDF]
US Health Care Flexible Spending Account [PDF]
US Teladoc Medical Experts SPD [PDF]
US Workers' Compensation Predesignation Form [PDF]
US Workers’ Compensation Claim Form [PDF]

Health and wellbeing—Medical

US Aetna HDHPs Benefit Plan Booklet 2023 [PDF]
US Aetna HealthSave Basic SBC 2024 [PDF]
US Aetna HealthSave Basic Schedule of Benefits 2023 [PDF]
US Aetna HealthSave Basic Schedule of Benefits Utah Connected 2023 [PDF]
US Aetna HealthSave SBC 2024 [PDF]
US Aetna HealthSave Schedule of Benefits 2023 [PDF]
US Aetna HealthSave Schedule of Benefits Utah Connected 2023 [PDF]
US Aetna OOA HealthSave SBC 2024 [PDF]
US Aetna OOA HealthSave Schedule of Benefits 2023 [PDF]
US HMSA Benefits At-A-Glance Medical Rx Dental Vision 2022-2023 [PDF]
US HMSA CompMed Guide to Medical Benefits 2022 [PDF]
US HMSA CompMed Rx Rider 2022 [PDF]
US HMSA HI SBC 2023 [PDF]
US Kaiser CA HMO SBC 2024 [PDF]
US Kaiser NorCal Chiro & Acu Evidence of Coverage 2024 [PDF]
US Kaiser NorCal Evidence of Coverage 2024 [PDF]
US Kaiser SoCal Chiro & Acu Evidence of Coverage 2024 [PDF]
US Kaiser SoCal Evidence of Coverage 2024 [PDF]
US Kaiser WA HMO Evidence of Coverage 2024 [PDF]
US Kaiser WA HMO SBC 2024 [PDF]

Health and wellbeing—Dental and vision

US Delta Dental Claim Form [PDF]
US Delta Dental Evidence of Coverage [PDF]
US Delta Dental Plan Highlights 2024 [PDF]
US HMSA Dental Guide to Benefits 2022 [PDF]
US HMSA Vision Rider 2022 [PDF]
US Vision Plan Summary by VSP 2024 [PDF]
US Vision Service Plan Evidence of Coverage [PDF]
US VSP Out-of-Network Reimbursement Form [PDF]

Health and wellbeing—Workers' compensation

US California—Aviso a los Empleados—Lesiones Causadas por el Trabajo [PDF]
US California—Facts about Workers' Compensation [PDF]
US California—Notice to Employees—Injuries Caused by Work [PDF]

Healthcare notices

US ACA State Healthcare Exchanges 2021 [PDF]
US Adobe Exchange Notice 2024 [PDF]
US Adobe HIPAA Privacy Notice 2024 [PDF]
US Adobe Provider Choice Rights Notice 2024 [PDF]
US Adobe Self Service Tool Notice 2024 [PDF]
US Adobe Summary Annual Report (SAR) 2020 [PDF]
US Adobe Summary Annual Report (SAR) 2021 [PDF]
US Adobe Summary Annual Report (SAR) 2022 [PDF]
US Adobe Summary of Material Modifications & Reductions (SMM/SMR) 2022 [PDF]
US Adobe Summary of Material Modifications (SMM)—Interns [PDF]
US Adobe Summary of Material Modifications (SMM/SMR) 2023 [PDF]
US Adobe Summary of Material Modifications (SMM/SMR) 2024 [PDF]
US CHIP/Medicaid Notice 2024 [PDF]
US HIPAA Notice of Special Enrollment Rights 2024 [PDF]
US Medicare Prescription Drug Notice 2024 [PDF]
US Newborns and Mothers Health Protection Act 2024 [PDF]
US No Surprises Act notice (Aetna) [PDF]
US No Surprises Act notice (HMSA) [PDF]
US No Surprises Act notice (Kaiser) [PDF]
US No Surprises Act notice 2024 (Adobe) [PDF]
US Outbreak Period Notice 2023 [PDF]
US Transparency—MRFs Aetna
US Transparency—MRFs HMSA
US Transparency—MRFs Kaiser
US Women’s Health and Cancer Rights Act 2024 [PDF]

Retirement and financial

US 401(k) Plan Summary Annual Report 2020 [PDF]
US 401(k) Summary Plan Description [PDF]
US Deferred Compensation Overview 2024 [PDF]
US Life and AD&D Class 1 Certificate ($50k) [PDF]
US Life and AD&D Class 1 Certificate (3x Salary) [PDF]
US Life and AD&D Policy [PDF]

Retirement and financial–acquired companies

US Allegorithmic 401(k) Plan Summary Annual Report 2018 [PDF]
US Allegorithmic 401(k) Plan Summary Annual Report 2019 [PDF]
US Bizible 401(k) Plan Notice to Interested Parties [PDF]
US Bizible 401(k) Plan Summary Annual Report 2020 [PDF]
US Bizible 401(k) Plan Summary Annual Report 2021 [PDF]
US LiveFyre 401(k) Plan Summary Annual Report 2018 [PDF]
US Magento 401(k) Plan Notice to Interested Parties [PDF]
US Magento 401(k) Plan Summary Annual Report 2019 [PDF]
US Magento 401(k) Plan Summary Annual Report 2020 [PDF]
US Magento 401(k) Plan Summary Annual Report 2021 [PDF]
US Marketo 401(k) Plan Notice to Interested Parties [PDF]
US Marketo 401(k) Plan Summary Annual Report 2020 [PDF]
US Marketo 401(k) Plan Summary Annual Report 2021 [PDF]
US Marketo Welfare Benefit Plan Summary Annual Report 2018 [PDF]
US TubeMogul 401(k) Plan Summary Annual Report 2019 [PDF]
US TubeMogul 401(k) Plan Summary Annual Report 2020 [PDF]
US Workfront 401(k) Plan Summary Annual Report 2022 [PDF]

Time off

Global Holiday Calendar 2024 [PDF]
Global Unpaid Personal Leave Policy [PDF]
US Adobe Leaves of Absence Policy Overview [PDF]
US Adobe STD VDI Opt In Form [PDF]
US Adobe STD VDI Opt Out Form [PDF]
US Family and Medical Leave Act Policy [PDF]
US Family Care Leave Policy [PDF]
US FMLA Calculation Change – Employee Notice [PDF]
US Intern Time Off Policy [PDF]
US Long-Term Disability Certificate Class 1 (Officers) 2021 [PDF]
US Long-Term Disability Class 2 Certificate 2021 [PDF]
US Long-Term Disability Policy [PDF]
US Medical Leave Policy [PDF]
US Parental Leave Policy [PDF]
US Sabbatical Policy [PDF]
US Short Term Disability Plan [PDF]
US Short-Term Disability Class 1 Certificate (non-commissioned non-VDI) [PDF]
US Short-Term Disability Class 2 Certificate (commissioned non-VDI) [PDF]
US Time Off—Exempt Policy [PDF]
US Time Off—Non-Exempt Policy [PDF]
US Voluntary Disability Statement of Coverage [PDF]

Time off – statutory notices

US Colorado Paid Family Medical Leave Notice [PDF]
US Connecticut Paid Family Medical Leave Policy [PDF]
US MA Paid Family Medical Leave Mandatory Notice [PDF]
US Notice to California Employees Regarding Disability Coverage [PDF]
US Oregon Paid Family Medical Leave Notice [PDF]

Work and life

Global Adoption Assistance Program [PDF]
Global Business Travel Accident Summary of Benefits [PDF]
Global Business Travel Accident Summary Plan Description [PDF]
Global Education Reimbursement Form [PDF]
Global Education Reimbursement Program [PDF]
Global Lost or Delayed Baggage Claim Form [PDF]
Global Professional Development Acknowledgement Form [PDF]
Global Professional Development Program Policy [PDF]
US Alternative Work Arrangement Request Form [PDF]
US Dependent Care Flexible Spending Account [PDF]
US Group Legal Summary Plan Description [PDF]
US Learning Fund: graduate education reimbursement policy [PDF]
US Long-Term Care Brochure [PDF]
US Long-Term Care California Disclosure [PDF]
US MetLife Legal Plans Overview [PDF]
US Surrogacy Assistance Program [PDF]
US Telecommute Furniture Order Form [PDF]