I.B.E.W Local 234 Benefit Fund

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Health Care Documents

Recent Mailings

	IBEW 234 Creditable Coverage Notice 2022

	IBEW 234 H&W Plan Annual Notice 2022

	Notice of Privacy Practices for the IBEW Local 234 Health and Welfare Plan 03-2021

	April 2021 - Summary of Material Modification

	Anthem ABA Therapy Flyer 2021

	Medicare Advantage Enrollment Guide

	Medicare Advantage Card-Preview

	Anthem Medicare Advantage Notice of change 2021

	IBEW 234 Telehealth SMM

	IBEW 234 SMM - Cares Act (expanded)

	Medicare House Call Program First Visit Brochure

	Live Health & COVID19 info - Summary of Material Modification

	Anthem Live Health Flyer

	IBEW 234 SAR 2021 Plan Year (to Mail 2023)

	IBEW 234 Self Pay Rates Notice Eff. 11-1-2023

Forms

	Authorization Agreement for Direct Payments

	Authorization for Release of Protected Health Information

	Coordination of Benefits Form

	Enrollment Form

	HRA (BennyCard) Claim Form

	Retiree Healthcare Application

	Sav-RX Mail Order Form

	VSP Member Reimbursement Form

Summary Plan Description & Amendments

Summary of Benefits and Coverage

Information

	Delta Dental Benefits Summary

	Delta Dental Evidence of Coverage (EOC)

	Grandfathered Health Plan Notice

	Blue Cross/Blue Shield Global Core - Brochure

	Medicare Advantage Plan Webinar eff. 3/1/21

	Anthem Medicare Advantage Plan - LiveHealth Online

	Anthem Medicare Advantage Plan - Sydney Health App

	Anthem Medicare Advantage Plan - Virtual Health Programs

	Anthem Medicare Advantage Plan - House Call Program

	HRA Eligible Expenses List Revised 10.2021

	No Surprise Act Notice 2022

	VSP Benefit Summary