Tuesday, February 24, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
Notice of Privacy Practices - Effective February 16, 2026
Mailed 07/29/2025 SMM Delta Dental PPO and HRA Eligibility
Mailed 04/03/2025 CA Early & Medicare Retiree Self-Payment Contribution Rate Change
Mailed 01/23/2025 SMM D&D Benefits - Short Term Rehab – Adynovate
Mailed 04/03/2025 NV Early & Medicare Retiree Self-Payment Contribution Rate Change
Mailed 10/02/2024 Children's Health Insurance Program (CHIP)
Mailed 10/02/2024 Notice of Creditable Coverage - Med Part D
Mailed 10/02/2024 WHCRA, Newborns' & Mothers' Act, Privacy Practices
Mailed 09/19/2024 HRA Benefit Increase $1500 Effective October 1, 2024
Mailed 07/25/2024 Summary Annual Report PYE 9/30/23
Mailed 07/17/2023 SMM for Autism Spectrum Disorder Benefit
Health Care Forms
Health Care Forms
Member Reimbursement Claim Form
Health Reimbursement Arrangement (HRA) Claim Form
COBRA Continuation Coverage Rights
Enrollment Form - CA
Enrollment Form - NV
Beneficiary Form (Operating Engineers Local 501 Security Fund ONLY)
PHI Form & Instructions
Retiree Health Care Application
Disability Waiver Cover Letter
Total Disability Form
Retiree Self-Payment Deduction Authorization Form
Summary Plan Description and Amendments
Summary Plan Description and Amendments
CA Summary Plan Description and Plan Document Effective 1/1/2023
CA Plan Amendment No.1 - Laser Eye Surgery
CA Plan Amendment No.2 - HRA Benefit Increase
CA Plan Amendment No.3 - Autism and RX Injectables and Specialty Drugs
CA Plan Amendment No.4 - NSA Changes
CA Plan Amendment No.5 - D&D Benefits
CA Plan Amendment No.6 - HRA Proration
NV Summary Plan Description and Plan Document Effective 1/1/2023
NV Plan Amendment No.1 - Laser Eye Surgery
NV Plan Amendment No.2 - HRA Benefit Increase
NV Plan Amendment No.3 - Autism and RX Injectables and Specialty Drugs
NV Plan Amendment No.4 - NSA Changes
NV Plan Amendment No.5 - D&D Benefits
NV Plan Amendment No.6 - HRA Proration
NV Weekly Disability Benefit Summary Plan Description
Form 5500 for Plan Year Ended 9-30-23
Summary of Benefits and Coverages (SBC)
Summary of Benefits and Coverages (SBC)
Anthem PPO CA Active and Early Retiree SBC 01-01-26 to 12-31-26
Anthem PPO NV Active and Early Retiree SBC 01-01-26 to 12-31-26
Anthem Employee Assistance Program (EAP) Service Summary Effective 07/01/23
Anthem Personalized Support for Autism Caregivers
Anthem Autism Program
Health Plan of Nevada (HPN) HMO SBC Active Effective 01-01-26 to 12-31-26
Health Plan of Nevada (HPN) Preventive Care Flyer
Health Plan of Nevada (HPN) Points of Care Flyer
Health Plan of Nevada (HPN) SHL Mobile App Flyer
Kaiser Actives SBC 05/01/25-04/30/26
Kaiser Retirees SBC 05/01/25-04/30/26
Kaiser Maintenance Attendants SBC 05/01/25-04/30/26
MINES (Employee Assistance Program) - Nevada Participants Only
Revive (Formerly SwiftMD) Transition Guide - Indemnity PPO Participants
VSP Laser VisionCare Program
VSP Summary of Benefits (CA) Effective 11/01/2024
VSP Summary of Benefits (NV) Effective 11/01/2024
Dental Benefit Highlights
Dental Benefit Highlights
2025 Delta Dental Retiree PPO Group No. 04741
2025 Delta Dental Active PPO Group No. 04880
2025 Delta Dental Active HMO CA - Group No. 76460-00001
2025 Delta Dental Active HMO CA MA - Group No. 76460-00003
2025 Delta Dental Retiree HMO CA - Group No. 76467-00001
2025 Delta Dental Retiree HMO NV - Group No. 76460-00003
2025 Delta Dental Active HMO NV - Group No. 76467-00002