Arizona Pipe Trades Trust Funds

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Health Care Documents

Health Care Recent Mailings

Health Care Forms

	Address Change Form

	Paperless Consent Letter - Form

	PHI-Authorization for Release of Protected Health Information

	Early Retiree Dental/Vison Reimbursement Claim Form

	Weekly Disability Claim Form

	Active Employees Vision Reimbursement Claim Form

	Beneficiary Designation Form

	HRA Claim Form

	Enrollment Form

Summary of Benefits and Coverages

	Cigna SBC Actives, COBRA, & Early Retirees

	Cigna SBC Actives with Double Coverage

	Delta Dental Summary of Benefits

	Lyra Health

Health Care Documents / Summary Plan Description

	SPD - Active Employees & Non-Medicare Retirees

	SPD - Retiree Only HRA

	Consumer Guide on Avoiding Balance Billings

Health Care Amendments and Summary of Material Modifications

	H&W Amendment No. 1

	H&W Amendment No. 2

	H&W Amendment No. 3

	H&W Amendment No. 4

	H&W Amendment No. 5

	H&W Amendment No. 6

	H&W Amendment No. 7

	H&W Amendment No. 8

	H&W Amendment No. 9

	H&W Amendment No. 10

	H&W Amendment No. 11

	H&W Amendment No. 12

	H&W Amendment No. 13

	H&W Amendment No. 14

	H&W Amendment No. 15

	H&W Amendment No. 16

	Retiree HRA Amendment No. 1

	SMM - Benefit Improvements eff 1/1/19 Amend 2

	SMM - Changes to Health Reimbursement Account Plan Benefits eff 1/1/18 Amend 3

	SMM - Changes to Vision Plan Benefits eff 9/1/19 Amend 4

	SMM - COVID-19 Treatment Amend 6

	SMM - Eligibility Waiver Amend 7

	SMM - Extended Hour Bank Credits for Indentured Apprentices Amend 14

	SMM - Dependent Maternity Care Amend 15