Wednesday, April 1, 2026

Health Care Documents

Machine Readable File - In Network
Machine Readable File - In Network
COMING SOON
Machine Readable File - Out of Network
Machine Readable File - Out of Network
OON MRF
HIPPA Privacy Notices
HIPPA Privacy Notices
HIPAA Notice of Privacy Practices [February 2026]
Participant Notice Re Changes to HIPAA Privacy Practices
Health Care Recent Mailings
Health Care Recent Mailings
Roofers Local 149 VSP Benefits Summary
Roofers Local 149 MetLife Grief Counseling
Roofers Local 149 Humana Member FAQ COVID-19
Effective April 1, 2020 Encompass will replace New Alternatives as the Funds EAP Provider
Roofers Local 149 SBT Fund SMM Notice MDLIVE June 2020
Roofers Local 149 MDLIVE Flyer June 2020
Roofers Local 149 Detroit Golden Dental Open Enrollment 2020
Roofers Local 149 Detroit Golden Dental Brochure 2020
Roofers Local 149 Detroit Creditable Coverage Notice 10-15-20
Roofers Local 149 Mid-MI Creditable Coverage Notice 10-15-20
Roofers Local 149 SBT Fund Detroit and Mid-MI COVID-19 Vaccine 2021
Roofer Local 149 Detroit Open Enrollment 2021 - 2022
Roofers Local 149 Mid-MI Open Enrollment 2021 - 2022
Coronavirus Antibody Testing letter
Coronavirus Antibody Testing
Roofers Local 149 Creditable Coverage 2021
Health Care Forms
Health Care Forms
Address Verification Change Form
Vital Information Form
HIPAA Disclosure Authorization
Instructions for completing Vital Information and HIPAA Disclosure Authorization
HIPAA Privacy Notice
Health Care Amendments and Changes
Health Care Amendments and Changes
June 2003 Self Payment Increase
July 2003 – COBRA Rate Increase
June 2004 – Retiree & Surviving Spouse Self-Pay Increase
January 2005 – Class “O” Coverage
February 2006 – Plan Changes
May 2006 – Plan Changes
September 2006 – Self-Pay Rates
November 2006 – Prescription 90 Day Supply
November 2006 – Injectible
January 2007 – Plan Coverage and Eligibility Rules
Notice of Creditable Coverage
Dependant Coverage
April 2007 - Summary of Material Modification
November 2007 - Plan Changes Notice
December 2008 - Plan Changes Notice
Jan 2010 - lan Changes Notice
August 2010 - Important Notice Regarding New Service
December 2010 - HAP Announcement Notice
Medicare Advantage Group MA PPO Benefit Overview
Roofers 149 Human SOB 2020
Roofers Local 149 Humana Rx SOB 2020
Roofers Local 149 SBT 4th Amendment 2013
Roofers Local 149 SBT Fund 1st Amendment 8/2012
Roofers Local 149 SBT Fund 2nd Amendment 6/2014
Roofers Local 149 SBT 3rd Amendment 7/2015
Roofers Local 149 SBT Fund 5th Amendment 2/2015
Roofers Local 149 SBT 6th Amendment 8/2016
Roofers Local 149 SBT 8th Amendment 2/2017
Roofers Local 149 SBT 9th Amendment 4/2017
Roofers Local 149 10th Amendment 6/2017
Roofer Local 149 SBT 1st Amendment 4/2018
Roofers Local 149 SBT 2nd Amendment 12/2018
Roofers Local 149 SBT 3rd Amendment 2/2019
Roofers Local 149 SBT 4th Amendment 2/2019
Roofers Local 149 SBT 5th Amendment 7/2019
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
Roofers Local 149 SBT Plan Document 2017
HIPAA Compliance Information
Your Benefit Plan
Golden Dental Open Enrollment 2019
Roofers Local 149 SBT MM SPD 2015
Roofers Local 149 SBT Fund Plan Document 2021
Summary of Benefits and Coverages
Summary of Benefits and Coverages
Elixir Over the Counter COVID Tests
How to get your FREE At-Home COVID-19 Tests
Elixir COVID-19 Vaccine Booster
Dental Open Enrollment
Dental Open Enrollment
Golden Dental Open Enrollment 2021
Open Enrollment
Open Enrollment
COMING SOON
Optum RX Announcements
Optum RX Announcements
Welcome Post Card - English
Welcome Post Card - Spanish
Specialty Pharmacy Welcome
Optum Digital Interactive
Home Delivery Program Order Form
Optum Commercial Claim Form
Vision
Vision
Roofers Local 149 Vision Benefits effective 9/1/18
Roofers 149 SBT VSP COVID-19 We are here to help! 2020
VSP Essential Medical Eye Care April-May 2020
Humana Benefits and Coverage
Humana Benefits and Coverage
Roofers Local 149 Humana Silver Sneakers Go App. 2020
Roofers 149 Humana On-Demand Member Flyer 2020
Roofers 149 COVID-19 Human Member FAQ
Roofers 149 Humana Summary of Benefits 2020
Roofers 149 Humana Rx coverage 2020
Humana COVID-19 Press Release 3/30/2020
Roofers 149 Humana Steps to Care for Members in Response to Coronavirus 3.9.2020
Humana Out-of-Network Flyer
LifeExpert
LifeExpert
Tech Support
Android Install Instructions
IOS Install Instructions