Benefits
Accommodation Booking Schedule
Click Here to Access the Bookings Calendar
Plan year begins January 1, 2022
Health Insurance Plans
Enrollment Forms
NOTE: Health Benefit Enrollment is only available through the Maryland's Statewide Personnel System (SPS Workday).
Rates
- Employee and Retiree Rate Sheet (pdf)
- Retiree with State Subsidy (pdf)
- ORP Rates with 16-25 + Years (pdf)
- 10 Month Employee Rates (pdf)
- Direct Pay Rate Sheet (pdf)
- Contractual/ Variable Hours Rate Sheet (pdf)
Flexible Spending
Prescription
- CVS Healthcare Handbook (pdf)
- CVS FAQ's (pdf)
- CVS Evidence of Coverage (pdf)
- Prescription Claim Form (pdf)
- Medicare Prescription Claim Form (pdf)
- Mail Service Order Form (pdf)
- Medicare Mail Service Order Form (pdf)
- CVS Caremark Website
- Temporary ID Card Commercial Plan
- Temporary ID Card EGWP Medicare Part D
Dental
- 2022 Delta Dental Benefits book (pdf)
- 2022 United Concordia Benefits book (pdf)
- Dental United Concordia
Forms
Term Life Insurance and Accidental Death and Dismemberment
- Metlife Life Insurance (Employees)
- Metlife Life Insurance (Retirees)
- Metlife Added Services
- Metlife Accidental Death and Dismemberment
Website: www.metlife.com/USMD
USM Optional Term Life Insurance Facts & Stats
USM FAQ Optional Term Life Insurance
USM Optional Life insurance Overview
Additional Benefits
Retirement Guides and Forms
Handbooks
Supplemental Retirement Plans
Forms
- 403(b) Roth After-Tax SRA - Deduction Authorization Form - FIDELITY
- 403(b) Pre-Tax SRA - Deduction Authorization Form - FIDELITY
- 457(b) Pre-Tax SRA - Deduction Authorization Form - FIDELITY
- 403(b) Roth After-Tax SRA - Deduction Authorization Form - TIAA
- 457(b) Pre-Tax SRA - Deduction Authorization Form - TIAA
- 403(b) Pre-Tax SRA - Deduction Authorization Form - TIAA
- Nationwide Enrollment Form 403(b) 457(b) 401k (pdf)
Guides
- Fidelity 403(b) (pdf)
- Fidelity 457(b) (pdf)
- TIAA 403(b)/ 457(b) (pdf)
- Nationwide (MSRP) 403b 457(b) 401k (pdf)
Appointments
State of Maryland Health Assessment Wellness Plan
Department of Benefits Management (DBM) Wellness Program
- Co-pay Waiver and Specialist Reduction Process (pdf)
- Wellness Activity Cheat Sheet (pdf)
- Medical Carrier Added Benefits (pdf)