Friday, January 23, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
ERISA 104(d) Notice 2017 Plan Year
Summary Annual Report 2017
Annual Federal Tax Notice 2019
Annual Funding Notice 2018
2019 Annual Notice WHRCA & NOCC
UPDATED Special Emergency Rules Notice 2020
UPDATED Special Emergency Rules Notice 2020 - Spanish
Flu Shot Notice - Indemnity 2020
Flu Shot Notice - Indemnity 2020 Spanish
Flu Shot Notice - Kaiser 2020
Flu Shot Notice - Kaiser 2020 Spanish
Flu Shot Notice - WHA 2020
Flu Shot Notice - WHA 2020 Spanish
2021 Annual Notice WHRCA & NOCC
Kaiser 07- 2022 SBC
Annual Funding Notice 2021
Flu Shot Notice - Indemnity 2022
Flu Shot Notice - Indemnity 2022 Spanish
Flu Shot Notice - Kaiser 2022
Flu Shot Notice - Kaiser 2022 Spanish
Flu Shot Notice - WHA 2022
Flu Shot Notice - WHA 2022 Spanish
2022 Annual Notice WHRCA & NOCC
WHA 2023 EOC Changes
Notice End of Public Health Emergency (COVID19)
Flu Shot Notice - Indemnity 2023
Flu Shot Notice - Indemnity 2023 Spanish
Flu Shot Notice - Kaiser 2023
Flu Shot Notice - Kaiser 2023 Spanish
Flu Shot Notice - WHA 2023
Flu Shot Notice - WHA 2023 Spanish
2023 Annual Notice WHRCA & NOCC
Health Care Forms
Health Care Forms
Enrollment Form
Beneficiary Form
COBRA Continuation Coverage Rights
PHI Form & Instructions
Vital Information Form
Magellan Rx Mail Order Form
PR 0-20-0_2022
PR 0-20-0_2022 Spanish
RX 10-30-50
RX 10-30-50 Spanish
Western Health Advantage Enrollment Change Form 10-01-18
Western Health Advantage Enrollment Change Form 10-01-18 Spanish
Health Care Changes
Health Care Changes
SMM - Temporary Amendment May 2020
SMM - Extend Waiver Skip Month through Feb 2022 and Open Enrollment Delay (Spanish)
SMM - Extend Waiver Skip Month through Feb 2022 and Open Enrollment Delay
SMM - Over the Counter COVID-19 Testing
SMM - Over the Counter COVID-19 Testing (Spanish)
SMM - Mental Health Coverage
Health Care Amendments
Health Care Amendments
Amendment 3
Amendment 4
Amendment 5
Amendment 6
Amendment 7
Amendment 8
Amendment 9
Amendment 10
Amendment 11
Amendment 12
Amendment 13
Amendment 14
Amendment 15
Amendment 16
Amendment 17
Amendment 18
Amendment 19
Amendment 20
Amendment 21
Amendment 22
Amendment 23
Amendment 24
Amendment 25
Amendment 26
Amendment 27
Amendment 28
Updated Summary Plan Description Coming Soon!
Updated Summary Plan Description Coming Soon!
COMING SOON
Newsletters
Newsletters
Kaiser Telehealth Flyer
Kaiser Telehealth Flyer Sp
COVID-19 Vaccine FAQs
Aetna COVID-19 Vaccine Member Email Template
Understanding mRNA COVID-19 Vaccines
Aetna COVID-19 Vaccine Member Email - Spanish
COVID-19 Vaccine FAQs - Spanish
Summary of Benefits and Coverages
Summary of Benefits and Coverages
SBC 2016 Plan A
SBC 2016 Plan B
LDD & ADD Benefits
Kaiser SBC 2016
Dental Benefits
WHA SBC 2016
VSP SBC 2017
SBC 2017 Plan A
SBC 2017 Plan B
SBC 2017 Plan C
SBC 2018 Plan A
SBC 2018 Plan B
SBC 2018 Plan C
Kaiser SBC 2018
Kaiser SBC 2019
SBC 2020 Plan A
SBC 2020 Plan B
SBC 2020 Plan C
Kaiser SBC 2020
WHA SBC 2020
Kaiser SBC 2021
Kaiser SBC 2022
Kaiser SBC 2023
SBC Plan A 2023
SBC Plan B 2023
SBC WHA 2023
Announcements
Announcements
Your Rights and Protections Against Surprise Medical Bills
UPDATED 2022 and Beyond Required NSA Notice SIHRTE Welfare Plan