Summary Plan Descriptions (SPD's)
Summary Plan Descriptions (SPD's) are summary descriptions of each of the respective benefit plans. Download the Summary Plan Description:
UCC Retiree Medical (934KB PDF)
| Forms | |
| Aetna Rx Mail Order Form (172KB PDF) | If you participate in the MAP Plus Plan, Medicare Supplement Plan or the Catastrophic Medical Plan this is your downloadable mail order drug enrollment form. |
| Aetna Prescription Drug Claim Form (188KB PDF) | When making a claim for prescription drug benefits reimbursement, this form must accompany itemized bills from your pharmacy. |
| Aetna Medical Claim Form (32KB PDF) | When making a claim for medical benefits reimbursement, this form must accompany itemized bills from your health care provider. |
| Aetna Spouse/Domestic Partner Insurance Information Form (40KB PDF) | UCC’s Medical Care Program has a requirement, called the Working or Retired Spouse/Domestic Partner Rule that, Spouses/Domestic Partners eligible for another employer’s subsidized medical plan must enroll in that plan in order to be covered by the UCC Plan. To document compliance with this rule, the Insurance Information Form must be completed each year for your Spouse/Domestic Partner if he or she is Pre-Medicare Eligible and you are covering him or her in MAP Plus or the Catastrophic Medical Plan. |
| Important Notice of Creditable Coverage (32KB PDF) | This notice has information about prescription drug coverage for the calendar year under the medical programs sponsored by The Dow Chemical Company and new Medicare prescription drug coverage offered by the government available January 1, 2006 for people with Medicare. |
| Important Notice of Non-Creditable Coverage (32KB PDF) | This notice has information about prescription drug coverage for the calendar year under the Catastrophic Medical Plan and new prescription drug coverage available January 1, 2006, for people with Medicare. |
Medical Premium Charts
To help you make an informed choice, we have provided a series of charts. The charts outline the costs, coverages and benefit levels for a specific plan.
Download a plan:
- UCC Retiree Medicare Supplement Plan (MSP) (52KB PDF)
- UCC Retiree Catastrophic Medical Plan (132KB PDF)
- UCC Retiree MAP Plus Plan (76KB PDF)
Medical Support Schedule
To help calculate your monthly premium, if you are on the Support Schedule, download the helpful booklet listed below.
- Calculating Premiums (76KB PDF)
| Who to Contact | |
| Retiree Service Center |
Toll Free: (800) 344-0661 Phone: (989) 636-0977 outside the continental U.S. |
| Aetna Member Services |
Toll Free: (800) 736-9369 (7DOWDOW) Phone: (610) 336-1000 outside the continental U.S. Web site: Aetna |
