Forms and Plan Documents
Forms and Plan Documents
Forms
401(k) Plan
Paper form to rollover your 401(k) to the Publicis 401(k) Plan
Dental Plan
Delta Dental of New York Claim Form
Disability
Request for Leave or Chronic Illness Support
Flexible Spending Accounts
HealthEquity Dependent Care Claim Form
HealthEquity Health Care Claim Form
Form
Affidavit of a Common Law Marriage
Affidavit of a Domestic Partner
Medical Plan
Reimbursement Form for Medical Travel
Well onTarget Fitness Program with Points Member Flyer
Summary Plan Description for Publicis Medical Plan
Summary of Benefits and Coverage Premier Plan
Summary of Benefits and Coverage HSA Plan
Summary of Benefits and Coverage Freelancer Plan
Summary of Benefits and Coverage Standard Plan
Medicare
Application for Enrollment in Medicare Part B
Medicare Request for Employment Information Form
New Hire Information for U.S. Employees
Benefits and Payroll Packet for New U.S. Employees
Prior Employment Questionnaire
Participation in the Publicis 401(k) Plan Questionnaire
Payroll
e-TIME Timesheet Historical Correction Form
ReSources Wisely Pay Adjustment Request Form
Prescription Drug Plan
CVS Prescription Reimbursement Claim Form
TRIP — Commuter and Parking
HealthEquity Commuter Card Special Handling Form
HealthEquity Substitute Receipt Form
Vision Plan
Plan Documents
401(k) Plan
Summary Plan Description for Publicis 401(k) Plan
Publicis 401(k) Plan Enrollment Guide
Guide to Publicis 401(k) Plan Enhancements
Publicis 401(k) Plan Notice to Interested Parties
Publicis 401(k) Plan Beneficiary Designation
Publicis 401(k) Plan Loan Policy
Additional Benefits
Auto, Homeowners and Renters Insurance (with Mercer)
Accident Insurance (with Aetna)
Critical Illness Insurance (with Aetna)
Hospital Indemnity (with Aetna)
Natural Disaster Digital Flyer
Hospital Indemnity Plan Summary
Portability Coverage Election Form
Rate Sheet (Accident, Critical Illness, Hospital Indemnity)
Aetna Supplemental Health Claims
Bright Horizons Program
Family Benefits | Parental Leave
FAQ | Additional Family Support
Registration Guide | Additional Family Support
Registration Guide | Back-Up Care
Registration Guide | College Coach
Dental Plan
Summary Plan Description for Publicis Dental
Publicis Dental Coverage with Delta Dental
Delta Dental Coordination of Benefits Information
Delta Dental Online Cost Estimator
Delta Dental Web Mobile Resources
Visit the dentist online with Delta Dental’s Virtual Consult
BrushSmart: A free oral wellness program
Toothpic: Remote check-ups with photos
LifePerks - Savings to smile about
Choose PPO or Premier (why stay in-network)
Member flyer: Online Account Setup-Login Instructions
Member video: Delta Dental PPO and Delta Dental Premier networks
Member video: Online resources from Delta Dental
Disability
Summary Plan Description for Publicis Long-Term Disability
Summary Plan Description for Publicis Short-Term Disability
How to Calculate Long-Term Disability Coverage
How to file a claim for disability or leave of absence
The Hartford Mobile Enhanced Portal Flyer
Employee Assistance Program
Summary Plan Description for Employee Assistance Program
Overview of Employee Assistance Program
Overview of LifeSpeak Educational Program
Managing the Transition Back to Work
Flexible Spending Accounts
Summary Plan Description for Publicis Health Care FSA
Summary Plan Description for Publicis Dependent Care FSA
Flexible Spending Account Quick Start Guide
Limited Purpose FSA Quick Start Guide
Freelancer/Temp Employee Information
Summary of Benefits and Coverage Freelancer Plan
2025 Publicis Benefits Guide for Freelancers
General Information and Important Notices
Publicis Administrative Information
Dependent to Age 26 Special Enrollment Notice
Verifying your dependent as a full-time student
2025 Publicis Benefits Guide for Employees
Health Advocate
Health Savings Account
Health Savings Account Overview
Leave of Absence
Leave of Absence Manual California
New York Paid Family Leave FAQs
Parental Adoption Leave Checklist
Short Term Disability Leave Checklist
The Hartford How to File a Leave Request Claim
Legal Notices
Health Insurance Marketplace Notice
HIPAA Notice of Privacy Practices
Notice to Employees Requesting Pregnancy, Family, Medical or Servicemember Leave
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
2025 Notice of Creditable Coverage for Employees
2025 Notice of Creditable Coverage for Freelancers
Legal Plan
Summary Plan Description for Publicis Legal Plan
Publicis Legal Plans Product Overview
Life or Accidental Death and Dismemberment
Summary Plan Description for Publicis Life and AD&D Insurance
Plan summary for supplemental life or AD&D insurance coverage
FAQ about life or accidental death and dismemberment insurance
Don’t forget to designate a beneficiary
Life Insurance Benefit Overview
Life Events
Gain or Loss of Coverage Event Guide
Publicis benefit changes by life event
Medical Plan
Summary Plan Description for Publicis Medical Plan
Summary Plan Description for Publicis Medical Plan
Summary of Benefits and Coverage Premier Plan
Summary of Benefits and Coverage HSA Plan
Summary of Benefits and Coverage Freelancer Plan
Summary of Benefits and Coverage Standard Plan
Deciding Where to Go for Medical Care That Saves You Money
Medicare Tips for Retiring or Terminating Employees
Benefits Value Advisor Product Overview
Procedures Guide for Qualified Medical Child Support Order Notices
Preventive Care Wellness Guide
Medical Travel Benefits - Summary of Material Modifications
Get the most out of your benefits
Understanding Network Providers
Mental Health Resources
Publicis Teladoc Mental Health Complete Flyer
TD Member Testimonial Marielena's Mental Health
Health Advocate Finding a Balance Flyer
Health Advocate Stress Management Flyer
Mental Health Making a Difference Webinar Flyer
New Hire Information for U.S. Employees
Benefits and Payroll Packet for New U.S. Employees
Timeline for Processing Benefits
Electronically rollover your 401(k) from a prior company
Payroll
IRS Releases Notice 1036 with Updates to 2018 Income-Tax Withholding Tables
Massachusetts Paid Family Leave Notice
NY Paid Family Leave Tax Withholding Update
Paycheck Inquiries and Replacement Checks
Prescription Drug Plan
PrudentRx Specialty Medication Copay Program
PrudentRx Specialty Medication Copay Program FAQs
Save Money with Generic Options
Specialty Medications at $0 copay with Prudent
RxCVS Premier PPO Rx Plan Summary
CVS Standard PPO Rx Plan Summary
CVS Caremark Plan Summary: Medical HSA Plan
CVS Caremark Advanced Control Formulary
CVS Caremark Advanced Control Specialty Formulary
CVS Caremark Maintenance Drug List
Summary Annual Reports
2022 Summary Annual Report (SAR) for the Publicis 401(k) Plan
2022 Summary Annual Report (SAR) for the Publicis Business Travel & Accident Insurance Plan
2022 Summary Annual Report (SAR) for the Publicis Disability Plan
2022 Summary Annual Report (SAR) for the Publicis Legal Services Plan
2022 Summary Annual Report (SAR) for the Publicis Life Insurance and Voluntary AD&D Plan
2022 Summary Annual Report (SAR) for the Publicis Vision Plan
Teladoc
Publicis Teladoc Gen Med How to Get Started Flyer
Publicis Teladoc Skip the ER Flyer
TD Social Media Video VO Dont Forget You have TD Services
Publicis Teladoc Gen Med and Mental Health Complete Services
Vision Plan
Summary Plan Description for Publicis Vision