Saturday, January 31, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
Important Notice Regarding Lifetime Maximum and Annual Maximum Dollar Limts for Fee-for-Service Medical Plan
Notice of Privacy Practices
Summary of Material Modification Regarding Amendment No.14
Summary of Material Modification Regarding Amendment No. 15
Summary of Material Modification Regarding Express Scripts
Summary of Material Modifications Regarding Updated Dental Schedule of Allowances
Summary of Material Modification Regarding Switch to Blue Shield Trio Plan
Summary of Material Modification Regarding Amendment No. 17
Summary of Material Modification Regarding Amendment No. 17- Spanish
Summary of Material Modification Regarding COVID 19 Test Kits for Partcipants Under the Fee for Service Plan
L2 HW - SMM Regarding CAA & Surprise Balance Billing
L2 HW Summary Annual Report PYE 04-30-2024
HW- SMM Regarding End Of COVID-19
SMM Regarding Increase to Annual Dental Maximum
Blue Shield SBC 2025
Children's Health Insurance Program (CHIP)
2025 Annual Womens Cancer Right Notice
2025 Creditable Coverage Disclosure
Health Care Forms
Health Care Forms
United Concordia Enrollment Form
Retiree Health Care Election Form
Vital Information Form
Reciprocity Form
Active Employee Health Care Election Form
Disability Application
Change of Address Form
HealthSmart Provider Lookup Overview
HealthSmart Provider Lookup Overview-Spanish
Over the Counter (OTC) COVID 19 Test Kits Reimbursement Form for Partcipants Under the Fee for Service Plan
HW Notice of Privacy Practices
2023/2024 Kaiser Summary of Benefits & Coverage(SBC)-Actives
2023/2024 Kaiser Summary of Benefits & Coverage(SBC)-Retirees
2024 Blue Shield Summary of Benefits & Coverage(SBC)
2023/2024 Fee-for-Service Plan Summary of Benefits & Coverage(SBC)
2024/2025 Fee-for-Service Summary of Benefits & Coverage(SBC)
2025- Brick Masons-103101- EU 0 SBC-Actives.pdf
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
Brick Masons' Health & Welfare Fund Plan Document -- June 2007
H&W Summary Plan Description 09-01-2015
HW Amendment No.18
H&W Plan Document Amendments 1-18
HW Amendment No.19
HW Amendment No.20
No Surprises Act Notice
H&W Plan Restatement 07-28-2023
Information Regarding COVID-19
Information Regarding COVID-19
Kaiser Flyer Regarding COVID-19 English
Kaiser Flyer Regarding COVID-19 Spanish
United Concordia Teledentistry Flyer
United Concordia Toothbrush Safety Flyer
Kaiser's Updated Telehealth Flyer (English & Spanish)
Kasier Flyer How to Wear Mask
Summary of Material Modification Regarding COVID 19 Test Kits for Partcipants Under the Fee for Service Plan
Machine Readable File In Network
Machine Readable File In Network
In-Network - MRF
Machine Readable File Out of Network
Machine Readable File Out of Network
Out of Network - MRF
Tax Forms
Tax Forms
1095B Client Notice