2024 Plan Documents & Forms

• Blue Plan Benefit Summary
• Blue Plan SBC
• Blue Plan SPD
  • 2024 Blue Plan Amendment
• Maize Plan Benefit Summary
• Maize Plan SBC
• Maize Plan SPD
  • 2024 Maize Plan Amendment
• 2024 HealthPartners Health Plan Guide

2024 Carleton College Health & Welfare Comprehensive Benefit “Wrap” Plan SPD

• HealthPartners Claim Form
• HealthPartners Preventive Medication List
• HealthPartners Excluded Medication List
• Notice of a COBRA Qualifying Event
• myMailRx Pharmacy Prescription Order Form

Employee Assistance Program (EAP) SPD

• Value Plan Benefit Summary
• Value Plan SPD
• Comprehensive Plan Benefit Summary
• Comprehensive Plan SPD
• Delta Dental Claim Form

• VSP Member Reference Card
• VSP Choice Member Benefit Summary
• VSP Choice SPD

Mid-Year Contribution Changes for Health Savings Account (HSA) – Done in Workday

Workday Guide (HSA Contribution Changes)

• TIAA Volume Submitter (Wrapped DC and SRA Plan) Document
• TIAA Defined Contribution (403b) Summary Plan Description (SPD)
• TIAA Supplement Retirement Account (SRA) Contribution Changes (Done in Workday)
  • Change Retirement Contribution Guide (in Workday)
• TIAA Lifetime Maximum Deferral Calculation Authorization
• TIAA Annual Retirement Plan Fee Disclosure Notice
• IUOE Central Pension Fund Website – Union Employees

Application for Financial Planning Reimbursement

• Flexible Spending Summary Plan Description
• Flexible Spending Claim for Reimbursement (Optum)

• CLSP (Catastrophic Leave Sharing Program) Description for Non-Exempt, Non-Union Staff
• CLSP (Catastrophic Leave Sharing Program) Donation
• Personal Leave of Absence Form 

• Group Basic Life & AD&D Certificate (Group 1)
• Group Basic Life & AD&D Certificate (Group 2)

Voluntary Long-Term Disability Certificate

• 2020 Health and Welfare Plan Summary Annual Report (SAR)
• 2020 Defined Contribution Plan Summary Annual Report (SAR)

• Vacation
• Sick
• College Holidays & Winter Break
• Floating Holidays 

ACM Business Travel Accident Insurance Plan and Summary Plan Document (SPD) 

Qualifying Events