Thursday, February 27, 2020

Health Care Documents


Health Care Recent Mailings
Health Care Recent Mailings
2020 Open Enrollment Notice
IBU Health Annual Notices 2019
IBU HRA 2019 Annual Notices
2019 Open Enrollment Notice
Smmary of Material Modifications (SMM) 11.1.2018
2019 IBU Trust PPO SBC
Health- 5500 for the plan year ending December 31, 2018
HRA- 5500 for the plan year ending December 31, 2018
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
Uniform Glossary of Health Coverage and Medical Terms
Moda Vaccine Flyer
Notice of Nondiscrimination
Privacy Notice
IBU NHBT PPO Plan SPD 6.1.19
IBU Rx Plan FAQ
Health Care Forms
Health Care Forms
Privacy-Authorization Form for Release of PHI
Privacy-Request for Restrictions on Use or Disclosure of PHI
Trust Plan Enrollment Form
HMSA Enrollment form 2019
Medical Plan Claim Form
Dental Plan Claim Form
Vision Claim Form
Rx Postal Prescripion Services
RX Claim Form for a Compounded Prescription
RX Claim Form
Supplemental Claim Form
Transportation and Alternative Housing Claim Form
Domestic Partner Autopay Form
Domestic Partner Affidavit
Beneficiary Form
Timeloss and Disability Waiver Form
Health Care Amendments and Changes
Health Care Amendments and Changes
No documents available.
Summary of Benefits and Coverages
Summary of Benefits and Coverages
2020 IBU Trust PPO SBC
2020 Kaiser N.CA SBC
2020 HMSA SBC
2020 Kaiser Hawaii SBC
2019 Kaiser NW (OR) SBC