Tuesday, June 16, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
Summary Annual Report - PYE 06-30-2025
Summary of Material Modifications - Amendment 1: MSK, GLP-1, HRA
2025 ACA Nondiscrimination Notice
Privacy Practices Notice 2026
Health Care Summary Plan Description (SPD) and Amendments
Health Care Summary Plan Description (SPD) and Amendments
Summary Plan Description -- Effective 1/1/2026
Amendment 1 - MSK Benefits, GLP-1 Auto-PA, HRA Reimbursement
Amendment 2 - New Residential Utility Worker Classifications
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