Thursday, February 5, 2026

Health Care Documents

Recent Mailings
Recent Mailings
New PBM - CVS Caremark Effective January 1, 2026
2026 Humana Advantage Plan Rate Change Notice
2024 EPT Summary Annual Report
2025 WHCRA & NMHPA Notice
2025 Notice Non-discrimination Section 1557
2025 Notice of Privacy Practices
2025 Non-discrimination Notice
2025 EPT CHIP Notice
2025 Creditable Coverage Notice
2025 Summary of Benefits & Coverage - Aetna Non-Medicare Retirees
2025 Summary of Benefits & Coverage - Aetna Residential
2025 Summary of Benefits & Coverage - Aetna Actives
2025 Summary of Benefits & Coverage - Kaiser Glasiers L740
2025 Summary of Benefits & Coverage - Kaiser Gypsum
2025 Summary of Benefit & Coverage - Kaiser Floor Covers MCR
EPT & Virta Health Program
EPT Monthly Status Slip Discontinuance Notice
Canopy EAP Benefit (Spanish)
Canopy EAP Benefit
EPT New Mobile Application
Maternity Leave Program Info
Assignment of Rights Change Notice - Effective August 1, 2020
Pre-Retirement Notification
OxyContin Appeal Letter
Forms
Forms
Enrollment Form
EPT Temporary Total Disability Application (TTD)
VSP OON Reimbursement Form
Disability Cover Letter & Application
Spanish EPT Beneficiary Form
Spanish EPT Enrollment Packet Forms
Spanish EPT Enrollment Form
Spanish EPT PHI Form
Aetna Reimbursement Form
Spanish Disability Cover Letter & Application 2021
Injury Detail Form 2022
Coordination of Benefits Form 02-04-2021
Voluntary Termination Request Form - Dependent Spouse
Voluntary Termination Request Form - Dependent Under Age 18
Voluntary Termination Request Form - Dependent Over Age 18
Address Change Form
Beneficiary Designation Form
PHI Authorization for Release of Protected Health Information
Vital Information Form
Amendments and Changes
Amendments and Changes
SMM - ED Prescriptions
SMM - Prescription Vitamins Eft 1/1/2026
SMM - Deferred Enrollment Retiree/Spouse
SMM - VSP Premium & Custom Progressive Lenses
SMM - Organ Transplants
SMM - Colorectal Screening
SMM - Dental Implants
SMM - Ambulance & Emergency Room
SMM - Delta Dental eff 1.1.2025
SMM - Genetic & Pharmacogenomic Testing
SMM - Surrogate_ Out of Country Coverage_Stepchildren Eff 6/1/2024
SMM - Prosthodontic Services In-Network OR ONLY Eff 5/1/2024
SMM - Naloxone OTC Eff 2/1/2024
Balance Billing Notice
Documents / Summary Plan Description
Documents / Summary Plan Description
VSP Benefit Summary 2025
EPT Delta Dental Benefit Summary
EPT Delta Dental FAQ
Summary Plan Description (SPD) - 2023 Spanish Version
2023 Summary Plan Description (SPD)