Benefits and Forms


Employee Benefits 2019

The Archdiocese provides eligible employees with quality benefits to assist with their wellbeing. As a benefit eligible employee, you are offered a quality health insurance plan which consists of medical, prescription, and dental benefits. You are also offered a retirement plan, flexible spending accounts, long term disability, an employee assistance program, an adoption assistance program, employer-paid life insurance, and voluntary life insurance.

Please see your benefits administrator at your parish/school/office/agency regarding eligibility and any benefit changes. If you are eligible to enroll, make a change, or cancel an elective benefit, all completed forms need to be submitted to your benefits administrator.


Employee Handbooks

Employee Handbook (Parishes)

Employee Handbook (Offices & Agencies)


Employee Benefit Booklets 2019

Archdiocesan Lay Employee Benefits Booklet 2018 – 2019 for July 1, 2018 through June 30, 2019

Archdiocesan Educators Benefits Booklet 2018 - 2019 for July 1, 2018 through June 30, 2019

Benefits Booklets for the 2019 - 2020 plan years will be coming soon.


Health Insurance for Medical, RX and Dental Plan

Medical Plan Major Provisions and Comparisons

UnitedHealthcare Standard Plan – Summary of Benefits

UnitedHealthcare Premier Plan – Summary of Benefits

UnitedHealthcare Drug Formulary

Annual Rights and Resources Disclosure

Employee Health Insurance Form

Mail-Order Prescription Form

Delta Dental Summary of Benefits

Employee Health Insurance Waiver Form

UnitedHealthcare Standard Plan Document

UnitedHealthcare Premier Plan Document

Annual Rights and Disclosure Notice with UHC

HIPAA Privace Notice


Spousal Surcharge Policy

Spousal Surcharge Frequently Asked Questions

403b Retirement Plan

To access your retirement plan information and/or change your Beneficiary, you may access the Retirement plans website at the following website link:

Employee Prudential Retirement Plan Get Started Guide

Employee Lay Retirement Plan Highlights - Prudential

Employee Lay Retirement Plan Document


Flexible Spending Accounts

Flexible Spending Account (FSA) Highlights

FSA Questions and Answers

FSA Medical Reimbursement Claim Form

FSA Dependent Care Reimbursement Claim Form

Flexible Spending Account Election Form


Life Insurance Plans

Hartford Basic 1x Salary Life Insurance – Summary of Benefits

Hartford Voluntary Life – Summary of Benefits

Hartford Voluntary Life Enrollment/Change Form

Hartford Personal Health Application Form

Hartford Life Beneficiary Designation Form


Long Term Disability

Unum Long Term Disability Highlights

Long Term Disability Education Information


Employee Assistance Program

Employee Assistance Plan Brochure 


Employee Wellness Programs and Wellness Incentive

The Archdiocese provides many preventative health services to eligible Archdiocesan employees. The Archdiocese provides preventative services to employees such as mammogram screenings, H&H Health Associates wellness screenings, and annual flu vaccines.

The Mercy Mammogram Van will visit the Cardinal Rigali Center for Archdiocesan employee screenings on Tuesday, June 18th and Friday, June 28th, 2019.  For more information and how to schedule your appointment please review the 2019 flyer.

Mercy Mammography Van Visit 2019    

Archdiocesan-paid H&H Health Associates Wellness screenings are held each year in March and September for all benefit eligible employees. To participate, please click on this link: to make an appointment for a health screening at a location close by your home or work. For additional information please refer to the following documents: 

Employee Wellness Incentive FAQ

Employee Wellness Form for wellness plan year 5/1/2018 - 4/30/2019

Employee Wellness Form for wellness plan year 5/1/2019 - 4/30/2020


Archdiocesan paid flu vaccinations are provided in October each year to all active Archdiocesan employees, spouses, and their dependent children.  We offer the flu vaccine to your dependent children 9-25 years old, however, ages 9-17 need to have their parent/guardian attend with them.  Additional information regarding the 2019 flu vaccination event will be posted in September 2019. 





Archdiocese Benefits Adminitrators Manual 2019

Marketplace Coverage Notice

Medicare D Notice

Handout for Benefit Terminations 2018 -2019 for July 1, 2018 through June 30, 2019

Prudential Retirement Parish Experience Guide for administrators

Prudential Retirement Internet Contribution Center (ICC) Reference Guide for administrators


For any employee benefit questions, please email or call 314.792.7546