Tuesday, February 3, 2026

Health Care Documents

Health Care Recent Mailings
Health Care Recent Mailings
2024 Annual Mailings - Women, Newborns, Privacy Practices
Medicare Retiree Memo (No Rate Increase 2025)
Non-Medicare Early Retiree Memo (No Rate Increase 2025)
Non-Medicare Early Retiree Memo (Rate Increase Family Coverage 2025)
SAR 2023 Mailed to Retirees
SAR 2023 & SMM Mailed to Active
Health Care Forms
Health Care Forms
Vital Form
Short Term Disability Claim Form
Member PHI Form
MRA Reimbursement Form
Health Care Amendments and Changes
Health Care Amendments and Changes
SPD Amendment #1 Dollar Bank Credits effective January 1, 2021
SPD Amendment #2 No Surprises, OTC COVID Test & 90-day RX effective May 1, 2022
SPD Amendment #3 Service Description Clarification effective April 8, 2022
SPD Amendment #4 Benefits effective November 1, 2022
SPD Amendment #5 COVID, LiveHealth, EAP effective August 24, 2023
SPD Amendment #6 Hyaluronan Injections effective November 28, 2023
Health Care Documents / Summary Plan Description
Health Care Documents / Summary Plan Description
SPD 2020
SBC High Plan 2025
SBC Low Plan 2025
SBC Mid Plan 2025
Notice of Nondiscrimination
Form 1095-B Request Instructions