Wednesday, December 4, 2024

Health Care Documents

Recent Mailings
Recent Mailings
Notice of Privacy Practices for the IBEW Local 234 Health and Welfare Plan 03-2021
IBEW 234 Summary Annual Report 2022 Plan Year (to Mail 2024)
IBEW 234 HW Plan SBC June 2024-2025
IBEW 234 Self Pay Rates Notice Eff. 11-1-2024
IBEW 234 Health Creditable Coverage Notice 2024
IBEW 234 HW Plan Annual Notice 2024
IBEW 234 Non-discrimination-Section 1557 Notice
Forms
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
Summary Plan Description & Amendments
Summary Plan Description & Amendments
Summary Plan Description - January 2023
Information
Information
Delta Dental Benefits Summary
Grandfathered Health Plan Notice
HRA Eligible Expenses  List Revised 10.2021
No Surprise Act Notice 2022
VSP Benefit Summary