Monday, April 28, 2025

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
2021 Summary Annual Report and Annual Notices
Health Care Forms
Health Care Forms
Enrollment Form
Health Care Amendments and Changes
Health Care Amendments and Changes
COVID-19 Temporary SMM 17W
SMM #1 - FINAL Jan 2018_Second-Tier Benefit_1 Final
SMM #1 - SPANISH FINAL Jan 2018_Second-Tier Benefit_1 Final
SMM#2 NO OON COV 3.1.2020
SMM#2 NO OON COV 3.1.2020_SPANISH
SMM #3 - Life Insurance Benefits effective 4.1.2020 Eng-Sp
SMM #4 -Amendment to Claims and Appeals Procedures for Weekly AS Benefits - English
SMM#4 - Amendment to Claims and Appeals Procedures for Weekley AS Benefits - Spanish
SMM #5 - COVID Vaccination
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
Final 17W SPD English with Cover_November 2017
Final 17W SPD Spanish with Cover_November 2017
Summary of Benefits and Coverages
Summary of Benefits and Coverages
2022 SBC - Tier 1
2022 SBC - Tier 2
2023 SBC - Tier 1
2023 SBC - Tier 2
2024 SBC - Tier 1
2024 SBC - Tier 2
Machine Readable File Out of Network
Machine Readable File Out of Network
COMING SOON