Thursday, June 18, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
PCA Substantiation Letter
BeneSys ARP Subsidy Summary and Application
Basic Family Buy Up eff. June 1, 2024
Health&Welfare Rate Increase Notice June 2024
Blomquist EE (2) May 2024
Blomquist EE May 2024
Annual Mailings 2024
2024 Notice of Creditable Coverage
Retiree Self-Payment Rates - Eff. 01-01-2025 - Revised
Mobile App Notice - Revised 2026
COBRA Rate Change Effective June 1, 2026
Health Care Forms
Health Care Forms
ACH Form (Retiree - Selfpay)
Address Change Form
Beneficiary Designation Form – Health
Coordination of Benefits
Cigna Claim Form
New Member Packet - New Hire
Retiree Application Packet
Temporary Total Disability
Enrollment Form - Active Regular
Enrollment Form - Active Non-Bargaining
Enrollment Form - Active Basic
COBRA Continuation Coverage Election Form
SAVRX Reimbursement Form
PCA Reimbursement Form
Vision Reimbursement Claim Form
PCA/WEX Card Transaction Dispute Form
Application for Dependent Death Benefits
Application for AD&D Insurance Benefit
Affidavit of Survivorship
Application for Life Insurance
Health Care Amendments and Changes
Health Care Amendments and Changes
COMING SOON
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
HIPAA Notice of Privacy Practices eff. 2.16.2026
Doctor On Demand Flyer
Dr. On Demand 8th Dst. Member Registration Guide
Hello Heart Registration Flyer
Basic Plan Summary Plan Description restated 01.01.2026
Active Plan Summary Plan Description restated 01.01.2026
Summary of Benefits and Coverages
Summary of Benefits and Coverages
2026 - IBEW 8th District SBC - Basic Plan
2026 - IBEW 8th District SBC - Regular Plan
Machine Readable File Out of Network
Machine Readable File Out of Network
Out of Network - MRF