BAC Local 2 Fringe Benefit Funds

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Health Care Documents

Health Care Recent Mailings

	Michigan Auto Insurance Update July 2020

	Welcome Letter to Newly Merged Michigan BAC Participants

	Summary of Material Modification BAC of Michigan Health & Welfare Plan May 2023

	2024 Open Enrollment Information, Summary of Material Modifications, and Summary of Benefits and Coverage

	2025 Summary of Benefits and Coverage & Annual Notices

	BAC of Michigan Health & Welfare Fund Summary Annual Report 2024

Health Care Forms

	Certification Letter for Self Payment

	Claim Report

	Credit Card Authorization on File

	Dependent Child Coverage Application Form

	Disability Benefit Breakdown

	Application for Disability Benefits Form

	Call A Doctor Welcome Letter and Activation Instructions

	BAC of MI Application For Death Benefits

	BAC of MI Vital Information Form 2022

	Self Pay Automatic Withdrawal Application

	Reciprocity Transfer Request Form - Bricklayers Pension Fund Metropolitan Area

	Reciprocity Transfer Request Form - Cement Masons Pension Trust Fund D&V

	Reciprocity Transfer Request Form - Michigan BAC Pension Fund

	Reciprocity Transfer Request Form - Tile International Pension Fund

	Cement Masons Pension - Assignment and Auth Request

	Bricklayers Pension - Assignment and Auth. Request

	2024 DenCap Forms

Health Care Amendments and Changes

Health Care Documents / Summary Plan Description

	Notice of Waiver Extension

	HIPAA Privacy Notice

	Summary of Material Modification 2016

	Autism Benefits Notice

	Benefit Changes 05 01 2014

	BAC of MI Summary Plan Description (SPD)

	BCBSM Health & Well-Being Online Resources

Summary of Benefits and Coverages

VSP

2025 Summary of Benefits and Coverage & Annual Notices