Saturday, April 4, 2026

Health Care Documents

Machine Readable Files - In Network
Machine Readable Files - In Network
COMING SOON
Machine Readable Files - Out-of-Network
Machine Readable Files - Out-of-Network
OON MRF
Health Care Recent Mailings
Health Care Recent Mailings
Roofers Local 149 MM Open Enrollment 2021 - 2022
Coronavirus Antibody Testing
Coronavirus Antibody Testing Flyer
Health Care Forms
Health Care Forms
Open Enrollment Form
Open Enrollment Notice
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
August 2005 - Notice Related to Drug Coverage
February 2006 Notice of Plan Changes
May 2006 – Notice of Plan Changes
November 2006 – Prescription 90 Day Supply
November 2006 – Injectible Immunomodulator
Notice of Creditable Coverage
Dependant Coverage
April 2007 - Summary of Material Modification
August 2010 - Important Notice Regarding New Service
December 2010 - HAP Announcement Notice
Medicare Advantage Group MA PPO Benefit Overview
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
Roofers Local 149 Mid-MI SBT Fund SPD 2021
Roofers Local 149 SBT Fund Plan Document 2021
How to get your FREE At-Home COVID-19 Tests
Vision
Vision
Roofers Local 149 Mid-MI Vision Coverage Letter 2018
Roofers Local 149 Mid-MI Vision Benefits effective 9/1/2018