Sunday, January 16, 2022

Health Care Documents


Health Care Amendments and Summary of Material Modifications
Health Care Amendments and Summary of Material Modifications
No Documents available
Health Care Forms
Health Care Forms
DELTA DENTAL ENROLLMENT FORM EFFECTIVE 10-1-2015
AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFO
DEPENDENT COVERAGE REQUIREMENTS
DISABILITY APPLICATION FORM
ENROLLMENT FORM
BENEFICIARY FORM
OTHER INSURANCE FORM
BHO MAP REFERENCE GUIDE
IRS Form 1095-B Notice
Health Care Mailings
Health Care Mailings
HCA REMAINS IN NETWORK NOTICE EFF 3-1-2016
VALLEY HEALTH SYSTEM HOSPITALS IN NETWORK EFF. 1-1-2017
HUMANA GROUP MEDICARE ADVANTAGE PLAN EFF. 1-1-2019
NOTICE OF NON VESTED BENEFITS 10-4-18
BANK HOUR MAXIMUM CHANGE EFF. 1-1-2019
Notice of Rx Gag Clause Changes 12-17-18
HUMANA MEDICARE PLAN - MEMBER NOTICE ABOUT PROVIDERS 03-27-19
HUMANA MEDICARE PLAN - PROVIDER FLYER 03-27-19
SMM HW - Return to Covered Employment - Medicare Retirees
WOMEN'S HEALTH & CANCER RIGHTS AND NEWBORNS' AND MOTHERS' HEALTH PROTECTION ACT NOTICE - OCTOBER 2019
Notice of COBRA Extension - COVID-19 Update
COBRA Rates Eff. 1-1-21
SMM H&W Amendment No. 1 - Emergency Use Authorization (EUA) Eff. 12-07-2020
SUMMARY ANNUAL REPORT - PYE 2020
COBRA Rates Eff. 1-1-22
Creditable Coverage Notice - October 2021
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
H&W SUMMARY PLAN DESCRIPTION EFF. 01-01-2020
SMM - H&W AMENDMENT NO. 1 - Emergency Use Authorization (EUA) Eff. 12-07-2020
SBC Effective 1-1-2022 to 12-31-2022