Wednesday, March 19, 2025

Employers Health Trust Fund Documents

Employers Health Trust Fund Recent Mailings
Employers Health Trust Fund Recent Mailings
SMM#21 02.01.2025 Cigna DHMO Dental Change Notice
SMM#20 Expanded Contraception and Dental Coverage
Teamsters-Local639-VSP Micro-Site Flier
Improved Vision Benefits Effective December 1, 2023
CVS Caremark OTC COVID Test Paper Claim Form
Web Site Registration Notice
2023 Mastectomy Notice
Medicare Part D Notice 2023
HIPAA Privacy Notice 2022
Employers Health Trust Fund  Forms
Employers Health Trust Fund  Forms
COB Form - Health
Enrollment Application - Health
Change of Address Form
Medical Claim Form
Affidavit of Spousal Health Care Coverage Form
Dependent Verification Form
Employers Health Trust Fund Amendments and Changes
Employers Health Trust Fund Amendments and Changes
2023 Disclosure Notice Regarding Patient Protections Against Surprise Billing
SMM#1_EFF 7-1-2011 Mail Order Program For Maintenance Drugs
SMM#2_EFF 1-1-2013 Improved Health Benefits
SMM#3_EFF 1-1-2014 Improved Mental Health Benefits Network Provider Changes
SMM#4_EFF 7-29-14 Limitation for Claim or Civil Action Fund or WC appeals
SMM#5_EFF 6-1-2015 Compound Meds Pre-Auth
SMM#6_EFF 4-1-2016 Specialty Pharmacy Guideline Management Program
SMM#7_EFF 1-1-2018  Opioid MAP and YHF
SMM#8_ EFF 10-1-2018 Outpatient Injectibles
SMM#9_EFF 7-1-2019 Workers' Compensation
SMM#10_EFF 1-1-2020  Specialty Prescription Drug Coverage
SMM#11_EFF 3-1-2020 COVID-19 Notice
SMM#12_EFF 3-1-2020 COVID-19 Cover 2nd Notice
SMM#13_EFF 11-1-2020 Extended Telehealth Visits
SMM#14 2022 Plan Improvement and Changes
SMM#15 Over-the-Counter COVID19 Test Kits
SMM#16 Mammogram and TeleHealth Coverage_2022
SMM#17 Non-Seasonal Vaccines and Genetic Testing
SMM#18 Telehealth Colonoscopies End of National Emergency
SMM#19 Improved Vision Benefits
SMM#20 Expanded Contraception and Dental Coverage
SMM#21 02.01.2025 Cigna DHMO Dental Change Notice
Employers Health Trust Fund Documents / Summary Plan Description
Employers Health Trust Fund Documents / Summary Plan Description
Summary Annual Report for Teamsters Local 639 Employer Health Trust 2018
Teamsters Local 639 Employers Health Creditable Coverage Notice 2019
Teamsters Local 639 Employer Health Fund Annual Mastectomy Notice 2019
Teamsters Local 639 Employers Health Fund - Summary Plan Description (SPD) 2011
Employers Health Trust Fund Summary of Benefits and Coverages
Employers Health Trust Fund Summary of Benefits and Coverages
2025 Teamsters Local 639 Summary of Benefits and Coverage (SBC)
2024 Teamsters Local 639 Summary of Benefits and Coverage (SBC)
2023 Teamsters Local 639 Summary of Benefits and Coverage (SBC)
Employers Health Trust Fund Summary Annual Report
Employers Health Trust Fund Summary Annual Report
2022 Teamsters Local 639 - Health Fund Summary Annual Report
2021 Teamsters Local 639 - Health Fund Summary Annual Report
2020 Teamsters Local 639 - Health Fund Summary Annual Report
2019 Teamsters Local 639 - Health Fund Summary Annual Report
2018 Teamsters Local 639 - Health Fund Summary Annual Report
Cigna DHMO Dental Services Covered and the Copay Schedule
Cigna DHMO Dental Services Covered and the Copay Schedule
Cigna DHMO Dental Services Covered and the Copay Schedule
Cigna DHMO Dental Provider Nomination Form
Cigna DHMO Dental Provider Nomination Form
Cigna DHMO Dental Provider Nomination Form