Thursday, February 25, 2021

Health Care Documents


Envision Rx Name Change
Envision Rx Name Change
EnvisionRx Flyer
EnvisionRx FAQ
Related Information - COVID-19
Related Information - COVID-19
EPT COBRA Subsidy Attestation Form
EPT COBRA Subsidy Announcement
Announcement of Benefit Changes for COVID-19
Teledoc - Getting Started
Teledoc FAQ
Recent Mailings
Recent Mailings
Summary Annual Report - Plan Year End July 31, 2019
Assignment of Rights Change Notice - Effective August 1, 2020
EnvisionRx Name Change Flyer
Prior-Authorization Change Notice - Effective May 1, 2014
Dental Benefit Change Notice - Effective March 1, 2020
Vision Benefit Change Notice - Effective August 1, 2020
Summary Annual Report - July 31, 2018
2019 Kaiser Active Summary of Benefits and Coverage
2019 Retiree Summary of Benefits and Coverage
2019 Residential Summary of Benefits and Coverage
2019 Active Summary of Benefits and Coverage
2019 Material Handler Summary of Benefits and Coverage
Glaziers Local 740 Kaiser Rate Change Notice Effective July 2019
Retiree Rate Change Notice - July 2019
Material Handlers COBRA Rate Change Notice - Effective November 1, 2018
Western Washington Painters COBRA Rate Change Notice - Effective November 1, 2018
Hourly Self Funded COBRA Rate Change Notice - Effective November 1, 2018
Hourly on Disability Extension COBRA Change Notice - Effective November 1, 2018
Glaziers Hourly Kaiser COBRA Rate Change Notice - Effective November 1, 2018
Floor Covering Hourly Kaiser COBRA Rate Change Notice - Effective November 1, 2018
Flat Rate COBRA Rate Change Notice - Effective November 1, 2018
Alaska Hourly Rate COBRA Rate Change Notice - Effective November 1, 2018
Alaska Flat Rate COBRA Rate Change Notice - Effective November 1, 2018
Pre-Retirement Notification
2018 Creditable Coverage Notice
Test Strip Appeal Letter
OxyContin Appeal Letter
Forms
Forms
Spanish Disability Cover Letter & Application 2021
Injury Detail Form 02-2021
Disability Cover Letter/Application 01.2021
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
VSP Out of Network Reimbursement Form
Enrollment Form
Address Change Form
Beneficiary Designation Form
PHI Authorization for Release of Protected Health Information
Vital Information Form
Amendments and Changes
Amendments and Changes
Summary of Material Modifications - Changes to the Retiree Eligibility Provisions for Union Employees Effective August 1, 2019
Summary Of Material Modifications - Changes to Extension of Benefits During Total Disability Effective June 1, 2019
Summary of Material Modifications - Changes to the Humana Medicare Advantage Prescription Drug Plan Effective January 1, 2019
Summary of Material Modifications - New Medicare Retiree and Medicare Dependents Health Plan Effective January 1, 2019
Summary of Material Modifications - Changes to Neurodevelopmental Disorder and Speech Therapy Benefits Effective September 1, 2018
Documents / Summary Plan Description
Documents / Summary Plan Description
2018 Plan Document and Summary Plan Description (Spanish)
2018 Plan Document and Summary Plan Description