Monday, February 2, 2026

Health Care Documents

Health Fund Video
Health Fund Video
HRA Health Fund Video
Health Care Recent Mailings
Health Care Recent Mailings
COMING SOON
Health Care Forms
Health Care Forms
Adult Dependent Enrollment
Family Status Change Form
Handicapped Child Coverage
HIPAA Disclosure Authorization
Life Insurance Beneficiary Designation
Medical Claim Form
Prescription Claim Form
Vision Claim Form
Spouse-Dependent Disenrollment
Vital COB Information Form
1095B Client Notice
Health Care Amendments and Changes
Health Care Amendments and Changes
Dec 2015 - Pre-authorizations
SMM - Dec 2015 - Disenrolling Adult Children
Amendment No. 1 - Initial Eligibility
Amendment No. 2 - Hours Bank
Amendment No. 3 - Hours Bank and Self Payments
Amendment No. 4 - No Surprise Billing Act
SMM - Hours Bank and Dental Maximum
Amendment 8 - Transplant Travel Expense
Benefit Improvements January 2025
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
SPD - Schedule of Benefits - 2021
SPD - Active Employees Plan - 2021
Active Plan - Summary of Benefits - Contacts - 2021
SPD - Retiree Health Plan - 2021
Retiree Plan - Summary of Benefits and Contacts - 2021
HIPAA Privacy Practices
No Surprise Billing Act Statement