Wednesday, April 21, 2021

Health Care Documents


Health Care Recent Mailings and Notifications
Health Care Recent Mailings and Notifications
COVID Antibody Testing Announcement
Labor First COVID-19 Announcement
Summary Annual Report: Health Plan
PDP Supplemental Plan Mailing 1-1-20
COBRA Mailing Increase 2-1-20
Rate Increase Mailing 4-1-20
Summary of Material Modifications: Shop Plan
2018 - Summary of Material Modifications
2018 Summary Annual Report
2017 - Notice of Creditable Coverage
2015 Summary of Material Modifications
Rate Increase  -  Retirees on EGWP
Vision Reimbursement Benefit
Required Communications with Rawlings
2016 Rate Increase
Summary of Benefits and Coverages
Summary of Benefits and Coverages
SBC 2020 UHC & EGWP Medicare Advantage
SBC 2020 Medicare Retiree PDP Supplemental
SBC 2020 Supplemental Retiree No Rx
SBC 2020 SHOP
SBC 2020 Active & Early Retirees
Health Care Forms
Health Care Forms
Vital Information Form/Update Beneficiary
2017 Vision Reimbursement Form
Express Scripts New Rx Physician Fax Form
HIPAA Authorization Form
Vital Information and HIPAA Authorization Form Instructions
Disability Form
Auto Deduction Form (Active)
Auto Deduction Form (Retiree)
HRA Form
Retiree Application Form
Express Scripts Mail Order Form
Health and Welfare Reciprocity - Transfer Out
Health and Welfare Reciprocity - Transfer In
Health Care Amendments and Changes
Health Care Amendments and Changes
Amendment 1
Amendment 2
Amendment 3
Amendment 4
Amendment 5
Amendment 6
Amendment 7
Amendment 8
Amendment 9
Amendment 10
Amendment 11
Amendment 13
Amendment 14
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
COVID-19 Resource
Live Health Online Registration Guide
Live Health Online Instructions
2019 Summary Plan Description
ASO and JAA Member Disclosure
2018 Plan Document
Avoid Balance Billing - Consumers Guide
Delta Benefit Summary
HIPAA Privacy Notice
January 1, 2013 Summary Plan Description