Monday, September 27, 2021

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 Annual Report for Plan Year Ended April 30, 2014
Summary of Material Modification Regarding Amendment No.14
Summary of Material Modification Regarding Amendment No. 15
2014 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
2015 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
Summary of Material Modification Regarding Express Scripts
Annual Creditable Coverage Notice October 2016
2016 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
Summary Annual Report Plan Year Ended April 30, 2016
2017 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
Annual Creditable Coverage Notice October 2017
Summary of Material Modifications Regarding Updated Dental Schedule of Allowances
2018 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
Annual Creditable Coverage Notice October 2018
Summary of Material Modification Regarding Switch to Blue Shield Trio Plan
Summary of Material Modification Regarding Amendment No. 17
2019 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
Annual Creditable Coverage Notice 2019
Summary of Material Modification Regarding Amendment No. 17- Spanish
Summary Annual Report Plan Year Ended April 30, 2019
Annual Creditable Coverage Notice 2020
2020 Womens Cancer Rights Act & Newborns & Mothers Protection Act Notice
Summary Annual Report for Plan Year Ended April 30, 2020
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
2021/2022 Kaiser Summary of Benefits & Coverage(SBC)-Retirees
2021/2022 Kaiser Summary of Benefits & Coverage(SBC)-Actives
2021 Blue Shield Summary of Benefits & Coverage(SBC)
2021/2022 Fee for Service Summary of Benefits & Coverage(SBC)
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
Plan Document Amendments 1 through 17
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