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Cement Masons and Plasterers Local 797 Benefit Funds
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Health Care Amendments and Summary of Material Modifications
Health Care Amendments and Summary of Material Modifications
COMING SOON
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 for 2023 Tax Year
Health Care Mailings
Health Care Mailings
NOTICE OF NON VESTED BENEFITS 10-4-18
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
Notice of COBRA Extension - COVID-19 Update
OTC COVID-19 Test Kits
SUMMARY ANNUAL REPORT - PYE 2023
CREDITABLE COVERAGE NOTICE 2024
Summary of Material Modifications Effective January 1, 2025
Women's Health & Cancer Rights, Newborns' and Mothers' Health Protection Act, Notice of Privacy Practices
COBRA Rates Eff. 01-01-2025
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 - Eff. 12-07-2020
SMM - H&W Amendment No. 2 - Eff. 07-01-2022
SMM - H&W Amendment No. 3 - Eff. 07-01-2023
SMM - H&W Amendment No. 4 - Eff. 05-11-2023
SMM - H&W Amendment No. 5 - Eff. 01-01-2024
SMM - H&W Amendment No. 6 - Eff. 05-01-2024
SMM - H&W Amendment No. 7 - Eff. 01-01-2024
SMM - H&W Amendment No. 8 - Eff. 01-01-2025
SMM - H&W Amendment No. 9 - Eff. 01-01-2025
VSP Benefit Summary Effective 7-1-2023
Summary of Benefits & Coverage (SBC) 1/1/2025 - 12/31/2025
Machine Readable File - In Network and Out-of Network
Machine Readable File - In Network and Out-of Network
Click here to access In Network and Out of Network Machine Readable Files. To access the files, copy the locations for each of the files into your browser. The allowed_amount_file is the out of network file.