Tuesday, January 20, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
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 04/03/2025 NV Early & Medicare Retiree Self-Payment Contribution Rate Change
Mailed 01/23/2025 SMM D&D Benefits - Short Term Rehab – Adynovate
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 01-01-25 to 12-31-25
Anthem PPO NV Active and Early Retiree SBC 01-01-25 to 12-31-25
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 01-01-2025 to 12-31-2025
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