Teamsters Local 922 Employers Health Trust Fund

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Health Care Documents

Participant Mailings

	2020 Summary Annual Report and Notices

	2021 Summary Annual Report and Notices

	2022 Summary Annual Report and Notices

Health Care Forms

	Proof of Death Form

	Short Term Disability Form

	ULLICO Life Insurance Beneficiary Form

Health Care Documents

Newsletters

Summary of Benefits and Coverages

Long Term Disability

	LTD Application Form

	Summary of Benefits and Highlights

	Additional Services Offered

Summary Plan Description and Amendments

	1.1.2024 SMM#5 Disability Benefit Change

	SMM - End of COVID

Open Enrollment Materials

	2024 Summary of Benefits and Coverage

	ULLICO Life Insurance Beneficiary Form

	Verification of Benefits Notice

	Participant Site and Long-Term Disability Notice

	Enrollment Form

	WMATA ONLY Enrollment Form

	WMATA ONLY Opt-Out Notice

	WMATA ONLY Co-Pays Notice

	WMATA ONLY 2024 Opt-Out Form