Dental School Contacts

• Employment Questions

John Brigada
Director of Finance & Administration
Office: 860-679-4065
E-mail: jbrigada@uchc.edu

• Program Questions

Eric R. Bernstein, J.D., Ed.D.
Interim Associate Dean for Academic Affairs
Office: 860-679-2672
E-mail: erbernstein@uchc.edu

Tax Forms

• W-4 Instructions.pdf
• W-4 Form.pdf
• CT W-4 Instructions.pdf
• CT-W4 Form.pdf

Medical and Dental

• Medical Overview.pdf
• Live Health Online.pdf
• Pharmacy Overview.pdf
  • Specialty Pharmacy/Drugs.pdf
  • Home Delivery Order Form.pdf
• Dental Overview.pdf
• Medical/Dental Benefit Booklet and Summary of Benefits and Coverage.pdf
• 2020 Benefits Notices Booklet.pdf
• Enrollment Application.pdf
• Medical/Dental Waiver Form.pdf
• Find an In Network Provider.pdf
• Out of Network Claim Form.pdf

Plan Documents

• Wrap Summary Plan Description.pdf
• Anthem Certificate of Coverage.pdf
• Section 125 Premium Conversion Plan.pdf

Vision

• Overview.pdf
• Application.pdf
• Blue View Waiver Form.pdf

Life Insurance

• Benefits Summary.pdf
• Life Insurance Change of Beneficiary Form.pdf
• Anthem Certificate.pdf

Insurance Benefits While Traveling

• Anthem International Travel.pdf
• Blue Card Claim Form.pdf
• Travel Assistance.pdf

Disability Insurance

• Disability Insurance.pdf
• Disability Conversion Information.pdf
• Disability Agent Contact Information.pdf

Work Related Injury - Workers' Compensation

• Work Related Injury - Workers' Compensation.pdf
• Purple Card Procedures.pdf
• Safety Committee Rosters.pdf

Malpractice.pdf

Banking Information

• Berkshire Bank
  • Exclusive Offer For New Residents.pdf
• Citizens Bank
  • Student Loan Refinance & New Loans
  • Doctors Mortgage Program
• People's United Bank.pdf
• Webster Bank
  • Exclusive Offer For New Residents.pdf
  • Financial Review.pdf

Financial Information

• Direct Deposit Authorization Form.pdf
• Instructions to View your Direct Deposit Paystub/W-2 Online.pdf
• Tax Sheltered Investment Program (403b).pdf

• Dependent Care Reimbursement Account (Pre-tax Childcare Expense).pdf

• Dependent Care Enrollment Form.pdf
• ADP Instructions
  • Request Paperless Statements.pdf
  • Register with ADP.pdf
• Investment Resources.pdf

Student Loan Debt Information

• AAMC Debt Management Resource
• Public Service Loan Forgiveness Form.pdf
• Debt Consolidation Information - Citizens Bank.pdf

Counseling Programs

• Anthem Resource Advisor.pdf
• Anthem Psychology Online – licensed therapy at home.pdf
• Guardian Employee Assistance Program.pdf

Discounts

• Go here to view discounts available to employees

Exiting Residents

• Exiting Instructions.pdf
• Payroll Forwarding Address.pdf

COBRA

• COBRA Election To Continue Benefits.pdf
• COBRA Election Notice.pdf
• COBRA Coverage Rights.pdf

COBRA ALTERNATIVES

• Health Insurance Exchanges.pdf