Sheet Metal Workers Union Local 162

Home > Documents > Health Care

Health Care Documents

Health Care Recent Mailings

	2025 Required Update to Privacy Practices Notice

	2025 Notice of Creditable Coverage

	2025 Privacy Practice Notice

	2025 Women Caner Rights Notice

	2025 CHIP Notice

	2024 Summary Annual Report

	SMM - TARP Termination - UnionEAP eff 5-1-25

	Self-Pay & COBRA Rate Changes Sch 1 eff 09-01-25

	RSV Vaccine & OptumRx Formulary - March 2024

	Dependent Audit - Part D Advisors - March 2024

	PBM Change to Optum and Intro of new MSK through Hinge Health benefit

	End of COVID-19 Emergency

	Protection Against Surprise Billing, Death Benefits, Hours Bank& Reimbursement

	No Surprise Act: Balance Billing Notice 2022

	2019 ACA Non-discrimination Notice w/ Language Insert

Health Care Forms

	Address Change Verification Form

	HRA Claim Form

	HIPPA Privacy Instructions and Forms

	Medical Reimbursement Claim Form

	Medical Claim Form

	Medical Claim Form - Disability

	Schedule 1 1A Enrollment Form

	VSP Member Reimbursement Form

	HRA Inter-District Transfer

Summary Plan Description (SPD) and Amendments

	SPD eff January 1, 2017

	Amendment 1 - Eligibility for Contributions

	Amendment 2 - Union Membership Lapses

	Amendment 3 - HRA Account Balance Transfers

	Amendment 4 - No Surprises Act Compliance

	Amendment 6 - Reserve Hour Bank

	Amendment 7 - Nutritional Counseling Exclusion

Summary of Benefits and Coverages