Friday, November 8, 2024

Health Care Documents


IBEW Local 595 Health Care Forms
IBEW Local 595 Health Care Forms
Affidavit of "Dependency" for Tax Purposes
Authorization for Release of Protected Health Information 2015
Beneficiary Card 2015
HRA Claim Form
Kaiser Enrollment & Change Form 2015
Monthly Status Report How to Read
New Member Packet
UHC Enrollment Form 2015
Authorization for Release of Protected Health Information 2013
Beneficiary Card
New Member Forms Check List
Authorization for Release of Protected Health Information
Eligibility Enrollment Form
Coordination of Benefits Form
Health & Welfare - HRA Authorization Deduction Form
Anthem - Medical Claim Form
Annual Summary of Benefits and Coverage
Annual Summary of Benefits and Coverage
Summary of Benefits & Coverage - UHC 2021
Summary of Benefits & Coverage - Kaiser Actives 2021 HMO
Summary of Benefits & Coverage - Kaiser Actives 2021 Spanish HMO
Summary of Benefits & Coverage - Kaiser Retirees 2021 Spanish
Summary of Benefits & Coverage - Kaiser Retirees 2021
Summary of Benefits & Coverage - Indemnity Additional Deductible PPO 2021
Summary of Benefits & Coverage - Indemnity PPO 2021
Benefit Info & Comparisons
Benefit Info & Comparisons
VSP 2017 - Evidence Certificate of Coverage
Health & Welfare - 2021 Comparison of Benefits
Health & Welfare - 2021 Dental Comparison
Notice of Creditable Coverage
Notice of Creditable Coverage
Notice of Creditable Coverage - 2020
Notice of Creditable Coverage - 2021
Participant Notices
Participant Notices
Health & Welfare - IBEW 595 CPAP Recall Postcard
BeneSys NSA Notice 12-2021
H&W - Optum Behavioral Flyer 2020
H&W - New Model - No Surprise Medical Billing Notice
January 2023 - HRA Mailings
Benefit Fair - March 4, 2023
Kaiser Permanente Strike
Form 1095-B
Rate Changes
Rate Changes
Health & Welfare - 2020 AMPC Rate Change (Alameda JATC)
Health & Welfare - 2020 AMPC Rate Change
Health & Welfare - 2020 AMPC Rate Change (Stockton JATC)
2022 AMPC Rate Change Notice August 2022
2023 AMPC Rate Change Notice August 2023
2024 AMPC Rate Change Notice August 2024
Summary Annual Report
Summary Annual Report
Summary Annual Report - HW PYE 1-31-2021
Summary Annual Report - HW PYE 1-31-2020
Summary Annual Report - HW PYE 1-31-2019
Summary Annual Report - HW PYE 1-31-2018
Summary Annual Report - HW PYE 1-31-2017
Summary Annual Report - HW PYE 1-31-2016
Summary Plan Description
Summary Plan Description
Summary Plan Description - H&W Effective 2-2021
WCR, Newborn & Privacy Practice Annual Notices
WCR, Newborn & Privacy Practice Annual Notices
WCRA & Newborn & Privacy Practices Annual Notice - 2018
WCRA & Newborn & Privacy Practices Annual Notice - 2019
WCRA & Newborn & Privacy Practices Annual Notice - 2020
Health Care Newsletters
Health Care Newsletters
Kaiser - 1-2021 Fitness Flyer - English
Kaiser - 1-2021 Fitness Flyer - Spanish
Kaiser - 11-2020 Diabetes Flyer - English Type 1
Kaiser - 11-2020 Diabetes Flyer - English Type 2
Kaiser - 11-2020 Diabetes Flyer - Spanish Type 1
Kaiser - 12-2021 Mind Body Wellness - English
Kaiser - 12-2021 - Mind Body Wellness - Spanish
Kaiser - COVID19 Children's Vaccinations
VSP - Essential Medical Eye Care Services - 6-2021
VSP - Annual Notice of Grievance Processes & Timely Access to Care
VSP - Eyeconic Overview with Benefit Integration English
VSP - Notice of Privacy Practices
Kaiser - 6-2022 Health Topic English
Kaiser - 6-2022 Health Topic Spanish
Kaiser - 7-2022 Monthly Newsletter
UHC - H&W - Lets_Move_UnitedHealthcare
Kaiser - 1-2023 Heart Health Flyer - English
Kaiser - 1-2023 Heart Health Topic Emails - English
Kaiser - 05/2023 Mental Health 1 - English
Kaiser - 05/2023 Mental Health 1 - Spanish
Kaiser - 05/2023 Mental Health 2 - English
Kaiser - 05/2023 Mental Health 2 - Spanish
Kaiser - 06/2023 Brain Health 1 - English
Kaiser - 06/2023 Brain Health 1 - Spanish
Kaiser - 06/2023 Brain Health 2 - English
Kaiser - 06/2023 Brain Health 2 - Spanish
Kaiser - 2023 Health Topic Flyer Travel 1 - English
Kaiser - 2023 Health Topic Flyer Travel 1 - Spanish
Kaiser - 2023 Health Topic Flyer Travel 2 - English
Kaiser - 2023 Health Topic Flyer Travel 2 - Spanish
June 2023 UHC Monthly Wellness Communication
UHC Health tip: Ergonomics and you
Kaiser - 02/2024 Health Topic Flyer Heart Health 1 - English
Kaiser - 02/2024 Health Topic Flyer Heart Health 1 - Spanish
Kaiser - 02/2024 Health Topic Flyer Heart Health 2 - English
Kaiser - 02/2024 Health Topic Flyer Heart Health 2 - Spanish
UHC Health tip: Understanding colds and flu
UHC August 2023 Monthly Wellness Communication
Kaiser - 03/2024 Nutrition Health 1 - English
Kaiser - 03/2024 Nutrition Health 1 - Spanish
Kaiser - 03/2024 Nutrition Health 2 - English
Kaiser - 03/2024 Nutrition Health 2 - Spanish
Kaiser Health Classes
VSP - Important Notice
July 2024 UHC Monthly Wellness Communication
VSP Vision Care Important Notice
Kaiser Permanente National News
Kaiser Permanente - Elevating Employee Well-being: Employer Webinar Series
Summary of Material Modification
Summary of Material Modification
Summary of Material Modification - H&W COVID-19 Eligibility Extension 7-2020
Summary of Material Modification - H&W Retiree Eligibility & Dollar Bank Forfeiture 9-2016
Summary of Material Modification - H&W Retiree Eligibility Years to Month 8-2016
Summary of Material Modification - H&W COVID-19 Eligibility Extension - 1-2021
Summary of Material Modification - H&W COVID-19 Eligibility Extension 4-2020
Summary of Material Modification - H&W Hearing Protection Plan 6-2020
Summary of Material Modification - H&W Generic Subscription Drug 3-2019
Summary of Material Modification - H&W COVID-19 Dollar Bank Freeze