Monday, January 19, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
Self Pay & COBRA Rate Increases 2025
SMM re: Indeminty GLP-1 Drugs eff. 07-2025
HRA Funding Notice - 2024 Contributions
Summary Annual Report - PYE 06-30-2024
SMM Re: UnionEAP 2025
Dependent Verification 2024
SMM Re: HRA, DPP, Dental, Dependents 2024
Children's Health Insurance Program Notice 2024
Women's Health & Cancer Rights Notice 2024
Medicare Notice of Creditable Coverage 2024
COBRA and Self Pay Rate Changes eff Oct. 2024
Summary of Material Modification - Medicare PBM, Dental Benefits, Domestic Partners
Medicare PBM Transition to OptumRx - 4.1.2024
Summary of Material Modifications - Amds 6, 7, 7A, 8, 9
2025 ACA Nondiscrimination Notice
Privacy Practices Notice 2024
Health Care Summary Plan Description (SPD) and Amendments
Health Care Summary Plan Description (SPD) and Amendments
Summary Plan Description 2021
Amendment 1 - Apprentice Eligibility
Amendment 2 - Genetic Testing
Amendment 3 - Dental Benefits
Amendment 4 - Dental Occlusal Guard
Amendment 5 - Living Donor
Amendment 6 - Out-Of-Work List
Amendment 7 - HRA Transfers
Amendment 7A - Substance Abuse & Detoxification Benefits
Amendment 8 - Dental Benefits Extension
Amendment 9 - Psychiatric care
Amendment 10 - Medical Benefits
Amendment 11 - Rx Benefits & WellAssist Program
Amendment 12 - Continuous Coverage Eligibility
Amendment 13 - SUB Benefits
Amendment 14 - Rx Benefits
Amendment 15 - Musculoskeletal Benefits
Amendment 16 - Dental Injuries for Minors
Amendment 17 - Domestic Partner Benefits
Amendment 18 - Employee Assistance Program, Diabetic Rx, Max OOP
Amendment 19 - OptumRx EGWP Provider
Health Care Forms
Health Care Forms
Address Change Verification Form
Benny Card FAQ
Benny Card IIAS Merchant Listing
Benny Card Introduction Letter 04/2009
Enrollment Form
HIPAA Privacy Instructions and Form
HRA Reimbursement Form
Kaiser Permanente Enrollment Form
Medical Claim Form - Disability
Member Reimbursement Medical Claim Form
Preventive Services Covered Under the Affordable Care Act
Statement of Medical Claim
SUB-SHC Application eff 02-2022
VSP Member Reimbursement Form
Summary of Benefits and Coverages
Summary of Benefits and Coverages
Indemnity SBC July 1, 2024 to June 30, 2025
Kaiser SBC September 1, 2023 to August 31, 2024
Indemnity SBC July 1, 2023 to June 30, 2024
Indemnity Plan Wellness Program eff January 2016
SBC Delta Dental Oct 1, 2021 to Sept 30, 2024
Delta Dental Flyer 2023
VSP Flyer
Non-Discrimination Notice w/ Language Insert
Benny Card Substantiation Requirement