Union Pacific Railroad Employe Health Systems

Some forms and publications are only available to existing UPREHS plan members. Please visit the member login link at the top of the website, or Click Here to visit the login page. Once you have logged in please visit the forms and publications link in that section of our website.

All forms and publications are Acrobat PDF documents. If you do not have Acrobat Reader, please download it now.

Medicare Prescription Information

Medicare and the New Health Law – What it Means for You (May 2010)

2012 Annual Notice of Change

2012 Preferred Part D Formulary

2012 Comprehensive Formulary

2012 Prime Medicare Plan Benefit Guide Part D

2012 HCPP Prime Medicare Plan Benefit Guide and Medicare A & B Secondary

2012 Summary of Benefits

Contact Us

Authorizations & Release Forms

Information Release Authorization
Revocation of Info Release Authorization
Automatic Dues Payment System Form

Benefits Guides & Summaries

Behavioral Health / Substance Abuse
2007 Intro to the HCPP Summary of Benefits
2007 HCPP Summary of Benefits
2009 Medicare Secondary & HCPP Benefits Guide
2007 Intro to the PDP Summary of Benefits
2007 Prime Medicare Plan Summary of Benefits
2009 Prime Medicare Plan Benefit Guide
2010 UPREHS Benefit Guide
2011 UPREHS Benefit Guide
Coordination of Benefits
Surviving Spouse Benefit Check List

Company Brochures & Newsletters

UPREHS Company Brochure
Preventing Fraud
Medicare & You 2012

HIPAA

HIPAA Privacy Notice

Health Information & Tips

Traveling with Insulin

Medicare Part D Prescription Drug Plan

2011 Formularies
2011 Preferred Part D Formulary
2011 Non-Preferred Part D Formulary
2011 Formulary for Active Members

2010 Formularies
2010 Preferred Part D Formulary
2010 Non-Preferred Part D Formulary

2009 Formularies
Active Member Drug Formulary
Retiree Drug Formulary
Medicare Preferred Drug Formulary
Medicare Non-Preferred Drug Formulary

Earlier Formularies
2008 Medicare Preferred Drug Formulary
2008 Medicare Non-Preferred Drug Formulary

Provider Nomination

Provider Nomination Form

Policies

Privacy Policies
Legal Disclaimers

Plan Coverage, Rules & Regulations

Challenger Plan
60/30 + Plan Summary - 2007
60/30 + Plan Rules & Regulations - 2003
ERMMB Plan Summary - 2007
Medicare HCPP/Supplemental Plan - 2007
Prime Medicare Prescription Drug Plan
Pensioner Under 65 - 2003
Pensioner Under 65 Supplemental Plan
CHC / MMCP Family Supplemental Plan
Prescription Copayments - All Plans

Report of Personal Injury

English
Español

Secondary Coverage for Dependents

Family Supplemental Brochure
Family Sup. Enrollment Application

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