Thursday, May 28, 2020

Health Care Documents


IBEW Local 595 Health Care Forms
IBEW Local 595 Health Care Forms
Affidavit of "Dependency" for Tax Purposes
Beneficiary Card 2015
HRA Claim Form
HRA Deduction Authorization Form 2015
Kaiser Enrollment & Change Form 2015
Monthly Status Report How to Read
New Member Packet
UHC Enrollment Form 2015
IBEW Local 595 Enrollment Form
Authorization for Release of Protected Health Information
Annual Summary of Benefits and Coverage
Annual Summary of Benefits and Coverage
Additional Deductible Indemnity Plan SBC 2/1/2016-1/31/2017
Additional Deductible Indemnity Plan SBC 6/1/2015 - 1/31/2016
Indemnity Plan SBC 2/1/2016-1/31/2017
Indemnity Plan SBC 2/1/2015 - 1/31/2016
Kaiser (Active) SBC 2/1/2016-1/31/2017
Kaiser (Medicare Retire) SBC 2/1/2016-1/31/2017
Kaiser (non-Medicare Retiree) SBC 2/1/2016-1/31/2017
Kaiser (Active) SBC 2/1/2015 - 1/31/2016
Kaiser (Medicare Retiree) SBC 2/1/2015 - 1/31/16
Kaiser (non-Medicare Retiree) SBC 2/1/2015 - 1/31/16
UHC (Active and Non-MediCare Retiree) SBC 2/1/2016-1/31/2017
UHC (Active and Non-MediCare Retiree) SBC 2/1/2015 - 1/31/2016
Kaiser (Active) SBC 2/1/2017-1/31/2018
Kaiser (non-Medicare Retiree) SBC 2/1/2017-1/31/2018
Additional Deductible Indemnity Plan SBC 2/1/2017 - 1/31/2018
Indemnity Plan SBC 2/1/2017 - 1/31/2018
Benefit Info & Comparisons
Benefit Info & Comparisons
Active Medical Comparison 2015
Delta Dental 2015
Dental Comparison (Act + Retiree) 2016
Dental Comparison (Act + Retiree) 2015
Medicare Retiree Medical Comparison 2016
Medicare Retiree Medical Comparison 2015
Optum Behavioral Health Member Assistance Program (MAP)
UHC Dental Benefits Summary 2016
UHC Dental Benefits Summary 2015
UHC Dental PUD Benefit 2015
UHC - How to Find a Network Doctor, Lab, Hospital or Facility - 2015
UHC Retiree Presentation 09-03-2015 - Medicare Advantage
VSP 2016
VSP 2015
VSP 2017 - Evidence Certificate of Coverage
Notice of Creditable Coverage
Notice of Creditable Coverage
2015 Notice of Creditable Coverage
2014 Notice of Creditable Coverage
2013 Notice of Creditable Coverage
2012 Notice of Creditable Coverage
2011 Notice of Creditable Coverage
Participant Notices
Participant Notices
ACA Exchange Notice 2013
ACEI Service Corp 60 Day Protection Plan
Affordable Care Act Summary of Material Modification
Anthem Blue Cross Notice of Breach 02 2015
Blue Cross ASO Member Booklet Disclosure SH 11 12 docx
RHA Rollover to HRA Notice 1-2015
Deactivation of HRA Debit Card Notice 10-2010
Delta Dental Annual Notice 2013
Delta Dental Paperless Campaign Flyer 3-2014
HRA Notice - Unused Accounts 10-2010
HRA Benny Card Introduction Letter
Important Notice for HRA Participants
IBEW Local 595 2013 Delta Dental EOC
Restated H&W SPD Notice 10 2015
RHA Balance Notice 7-11-2014
RHA HRA Roll-Over Letter 1-2014
RHA Rollover to HRA Account and Release Form 7-2014
Same Sex Marriage Notice (DOMA) 10-2013
Benny Card Information - June 2016
UHC Participant Notification - July 2016 - Mental Health & Substance Use Disorder Changes
UHC - Addendum to Summary of Benefit Coverage - Mental Health & Substance Use Disorder Benefits - July 2016
UHC - 2015 to 2016 Comparison - Mental Health & Substance Use Disorder Benefits
VSP Complaint Greivances Notification 2016
UHC Medicare PPO - Change to Calendar Year 1/1/2017 Notice
Benefits Fair Flyer 2017
Rate Changes
Rate Changes
AMPC & Self-Pay Rate Change Notice Effective 9-30-2015
AMPC & Self-Pay Rate Change Notice Effective 6-1-2014
Retiree Self-Pay Rate Change Notice Effective 4-1-2014
Summary Annual Report
Summary Annual Report
Summary Annual Report for Plan Year Ended 1-31-2015
Summary Annual Report for Plan Year Ended 1-31-2014
Summary Annual Report for Plan Year Ended 1-31-2013
Summary Annual Report for Plan Year Ended 1-31-2012
Summary Annual Report for Plan Year Ended 1-31-2011
Summary Plan Description
Summary Plan Description
Health & Welfare SPD
WCR, Newborn & Privacy Practice Annual Notices
WCR, Newborn & Privacy Practice Annual Notices
WCR & Newborn Notice 2015
WCR & Newborn Notice 2014
WCR & Newborn Notice 2013
WCR & Newborn Notice 2012
Notice of Privacy Practices 11-2013
Summary of Material Modification
Summary of Material Modification
Retiree Health Care Eligibility Changes 8-2016
Retiree Heath Care Eligiblity Changes 9-2016 & Retiree Dollar Bank Changes 9-2016