Saturday, January 24, 2026

Health Care Documents

Health Care Forms
Health Care Forms
Address Verification Change Form
Vital Information and Coordination of Benefits (COB) Form
Instructions for Completing the HIPAA Disclosure Authorization
HIPAA Disclosure Authorization
Dependent Eligibility Notice
HIPAA Privacy Practices
Elixir OTC Reimbursement Form
Summary of Material Modifications and Annual Notices
Summary of Material Modifications and Annual Notices
2022 Summary Material Modifications & Annual Notices - PPO / Construction
2022 Summary Material Modifications & Annual Notices - Medicare Retirees
2022 Summary Material Modifications & Annual Notices - HMO / Production
Health Care Documents / Summary Plan Description / Summary of Benefits
Health Care Documents / Summary Plan Description / Summary of Benefits
Summary of Benefits - PPO/Construction 2021
Summary of Benefits - HMO/Production 2021
Elixir / Envision Rx Benefits Summary 2021
Summary of Benefits - PPO/Construction 2020
Summary of Benefits - HMO/Production 2020
Production Summary Plan Description 2014
Construction Summary Plan Description 2014
Medicare Summary Plan Description 2014
Construction Summary Plan Description 2022
Medicare Summary Plan Description 2023
Production Summary Plan Description 2023
Health Care Participant Notices and Communications
Health Care Participant Notices and Communications
Pharmacy Benefit Manager Change Effective 6/1/2022
OTC COVID-19 Test Reimbursement Notice Effective 01/15/2022
Hearing Aid Benefit Improvements for PPO Plan and Self-pay Changes for Continued Eligibility - 2021 08 30
Medicare Retirees Med Advantage Provider Change Effective 1 1 2021
Non-Medicare PPO Early Retirees Provider Change Effective 1 1 2021
Construction (PPO) Annual Notices 2021
Production (HMO) Annual Notices 2021
Medicare Eligible Retirees Annual Notices 2021
Eligibility and Self-Pay Rate Changes Due to COVID 19 - May 2020
Coronavirus - BCBSM FAQs  March 2020
Coronavirus - BCBSM Customer Letter March 2020
New Auto Insurance Law - Effective July 2020
Coronavirus- Humana Press Release 2020
PPO Benefit Change - CPAP Cleaning Device Eff 8 2019
Spousal Death Benefit - Active and Non-Medicare Eligible Retirees Eff 11 1 2018
Medicare Eligible Retirees - Lasik Benefit Eff 1 1 2019
BCN HMO Benefit Changes Effective 6 1 2019
Eligibility Change - Dependent Spouse 2017
Senior Coach Employee Assistance Program - 2017
Senior Coach Employee Assistance Program Flyer - 2017
No Surprise Act Billing Notice
HIPAA Privacy Notice 2026
SMW 80 End of COVID-19 Notice - MAPD
BCBS Virtual Care - Online Visits
Trustee Roster
Trustee Roster
2025 Trustee Roster