Monday, February 2, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
Notice - Language Services
Summary Annual Report YE 2025 - Spanish
Summary Annual Report YE 2025
Mastectomy Notice 2025 - Combined
Medicare Notice 2025 - Combined
HIPAA Privacy Notice 2025 - Combined
Non Discrimination Notice 2025 - Combined
Health Care Forms
Health Care Forms
Disability Form - SPANISH
Disability Form
Enrollment Form
PHI Authorization Form
Subrogation Form
Health Care Amendments and Changes
Health Care Amendments and Changes
SMM #1 - Combined
SMM #2 - Combined
SMM #3 - Combined
SMM #4 - Combined
SMM #5 - Combined
SMM #6 - Combined
SMM #7 - Combined
SMM #8 - Combined
SMM # 9 - Combined
SMM # 10 - Combined
SMM # 11 - Combined
SMM #12 - Combined
SMM #13 - Combined
SMM #14 - Combined
SMM #15 - Combined
SMM #16 - Combined
SMM #17 - Combined w Flyer
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
SPD Revised 2019
Summary of Benefits and Coverages
Summary of Benefits and Coverages
SBC 2025 - Less than 2 Yrs
SBC 2025 - Retirees
SBC 2025 - 2+ Yrs
SBC 2025 - 2+ Years Spanish
SBC 2025 - Less than 2 Yrs Spanish
SBC 2025 - Retirees Spanish