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Health Care Documents

Healthcare Seminar Meeting Materials for October 05, 2024

	October 5, 2024 Health Care Benefits Seminar Invitation - Click QR Code to Register

	UA 393 HW Educational Seminar 10-2024

Formal Plan Rules and Amendments

SPD's and SMM's

	HW SPD January 01, 2026

	DCAFSA Summary Plan Description November 01, 2019

	SMM - Aetna Medicare Advantage Plan (MA) 01-12-2023

	SMM - Allowed Amounts July 2021

	SMM - Amendment 12 - Monoclonal Antibodies June 2021

	SMM - Amendment 18 - Dental December 2021

	SMM - Death Benefit March 2022

	SMM - Dental Benefit Enhancement and Other Reminders

	SMM - Dependent Care FSA - Amendment 2 June 2021

	SMM - Elimination of Walgreens and Krogers July 2022

	SMM - End to Temporary Suspension of Participant Deadlines May 2023

	SMM - H&W Amendment 21 August 2023

	SMM - New Healthcare Benefit Offerings 01-13-2023

	SMM - No Surprises Act December 2021

	SMM - Over-the-Counter COVID-19 Tests February 2022

	SMM - PPE Allowed for ERA Reimbursement April 2021

	SMM - Recent Amendments August 2020

	SMM - Amendment 29 October 2024

	SMM - Amendment 30 December 2024

	SMM - Amendment 33 March 2025

Forms and Applications

	Address Change Form

	Coordination of Benefits Form

	Death Benefit Beneficiary Designation Form

	Dependent Care Enrollment Form

	Enrollment Form - Commercial

	Enrollment Form - Residential Employees

	Extended Reserve Account (Benny/WEX card) Claim Form

	Long Term Disability Application

	Medical Reimbursement Form - Anthem PPO

	Protected Health Information (PHI) Release Form

	Paid Family Leave Application

	Retiree Coverage Election Form

	Retiree - ACH Payment Deduction Form

	Retiree - ERA Deduction Form

	Retiree - Pension Deduction Form

	Short Term Disability Application

	Short Term Disability Extension Form

	Dependent Care Claim Form

Useful Information and Important Notices

	Anthem Blue Cross PPO SBC - 2025

	Anthem Blue Cross PPO SBC - 2026

	BennyCard/ERA Information March 2017

	ERA Frequently Asked Questions (FAQ)

	E-Delivery Consent 2023

	No Surprises Act Notice 11-2022

	Notice of Privacy Practices

	Tips to Avoid Balance Billing

	New Member Welcome Guide 2024

	WEX - Digital Card

	Retiree Coffee Club HW Overview September 2024

	2025 Notice of Availability of Language Assistance Services and Auxiliary Aids and Services

	2025 Notice of Non-Discrimination - Section 1557

	2026 Self-Pay Rates - Non-Bargaining and Individual Employers

	2026 Self-Pay Rates - Medicare Retiree

	2026 Self-Pay Rates - Actives

	HW Summary Annual Report 2024

	UA Maternity Benefit Plan

	2025 Women's Health Notice

Delta Dental Benefits

	Delta Dental Benefit Highlights - Active & Retiree

	Delta Dental Benefit Highlights - Active & Retiree - Spanish

	Delta Dental Benefit Highlights - Residential

	Delta Dental Benefit Highlights - Residential - Spanish

	Delta Dental EOC - Active & Retiree 2023

	Delta Dental EOC - Residential 2023

	Delta Dental - Online Cost Estimator

	Dental Claim Form

	Delta Dental - Go PPO!

	Delta Dental - Submit Claims Online In No Time

	Delta Dental - You Have Options

Kaiser

	Kaiser Chiropractic Benefits 2020

	Kaiser Emergency Care Information

	Kaiser SBC 3/2025 - 8/2025 (Actives)

	Kaiser SBC 3/2025 - 8/2025 (Early Retirees)

	Kaiser SBC 3/2025 - 8/2025 (Residential)

	Kaiser EOC #1 - HMO Plan - Residential

	Kaiser EOC #2 - Chiropractic Services - Actives & Early Retirees

	Kaiser EOC #3 - Senior Advantage (HMO) with Part D - Residential

	Kaiser EOC #4 - HMO Plan - Actives & Early Retirees

	Kaiser EOC #5 - Senior Advantage (HMO) with Part D - Active & Early Retirees

	Kaiser EOC #12 - HMO Plan - Actives & Early Retirees

	Kaiser EOC #13 - Senior Advantage (HMO) with Part D - Active & Early Retirees

	Kaiser EOC #15 - Chiropractic Services - Actives & Early Retirees

	Kaiser EOC - Chiropractic Services - Residential

	Travel Coverage - Emergency and Urgent Care Away from Home

	One Pass Fitness Program - Medicare

Navitus: Prescription Drug Benefits (PPO Plan)

	Navitus Welcome Letter July 1, 2021

	Navitus Member Brochure July 1, 2021

	Navitus FAQ July 1, 2021

	Navitus Direct Member Reimbursement Claim Form

	Navitus MedicareRx - Notice of Enrollment (Medicare Only)

	Navitus MedicareRx - 2023 Summary of Benefits

	Navitus MedicareRx - 2023 Formulary List of Covered Drugs

VSP: Vision Benefits

	Essential Medical Eye Care Flyer

	Eyeconic Flyer

	VSP Benefits Summary

Hinge Health: Virtual Physical Therapy (PPO)

	Hinge Health Flyer

	Women's Pelvic Health 05-2023

	Enso: Control Back and Joint Pain

Health Advocate

	June 2025 Newsletter

	July 2025 Newsletter

	August 2025 Newsletter

	September 2025 Newsletter

	October 2025 Newsletter

	November & December 2025 Newsletter

	01-2026 & 02-2026 Newsletters

	How to Get Started With Online Access 2025

	Health Advocate Blog

	Fitness is for Life

	Simple Self-Care Tips to Prioritize Your Well-Being

	Sleep Better for a Healthier You

	Stay Strong Through Stress

	Suicide Prevention - You Are Not Alone

	Virtual Therapy

	Video - You Are not Alone

Virta: Diabetes · Prediabetes · Weight

	Flyer - Food as Medicine

	Video - Virta Health Experience

	Video - Virta Patient Experience

	Video - Our Members Say It Best

	Dr. Stanley Letter 09-2024