Thursday, January 29, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
Notice of Non-Discrimination
SMM: Short Hour Extension
SMM: Termination of Self Pay Extension
SMM: Death Benefits
SMM: Reinstatement of Self Pay Extension
SMM: Short Payment
SMM: Covid Vaccines
Privacy Practices Notice 2025
Women's Health and Cancer Rights Notice 2025
Language and Auxiliary Aids Services 2025
CHIP Notice 2025
Medicare Part D - Creditable Coverage Notice
Summary Annual Report
Retiree Self Payment Rates 2025
Non Bargaining Self Pay Rates 2025
Health Care Forms
Health Care Forms
Reciprocity Authorization Form.Home
Reciprocity Authorization Form.Traveler
COBRA Extended ARPA
Address Verification Form
Authorization for Self-Payment Deduction
Disability Physician Statement Form
Enrollment Form - Actives
Vital Information Form
Disabled Dependent Information
Beneficiary Form
New Member Packet
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
Health & Welfare SPD 2023
1st Amendment - Gene Therapy
2nd Amendment - Reimbursement Rights
3rd Amendment - COVID Screening & Testing
4th Amendment - Self Payment Provision
5th Amendment - Ground Ambulance
6th Amendment - Dependent Dental OOP Max
7th Amendment - 10k ADD Death Benefit
8th Amendment - Extending Short Hour Provision
9th Amendment - HIPAA Reproductive Privacy
10th Amendment - Self Pay Extension
11th Amendment - Short Payment
Newsletters
Newsletters
Sav-Rx Mobile App Flyer
Summary of Benefits and Coverages
Summary of Benefits and Coverages
Kaiser Active HMO SBC 3/1/2025 to 2/28/2026
Kaiser PPO SBC 7/1/2025 to 6/30/2026
Kaiser Retiree HMO SBC 3/1/2025 to 2/28/2026
United Health Care SBC 1/1/2025 to 12/31/2025