Wednesday, May 31, 2023

Health Care Documents

Health Care Forms
Health Care Forms
Accelerated Death Benefit (ADB), Accidental Death and Dismemberment (AD&D) or Waiver
Accident/Injury Form
Appeal Form
Claim Reimbursement Form
Cobra ACH Election
Disability Form
Life Insurance Claim Form
Over the Counter Covid Test Reimbursement Form
PHI Authorization
Privacy Practices
Subrogation
Reimbursement Agreement
Vision Benefits
Vital Form
Address Change Verification
Health Care Recent Mailings
Health Care Recent Mailings
SMM Changes 8/2022
Over The Counter Covid Test
Summary Annual Report 2021
UFCW Employee Transition Letters
Health Care Amendments and Changes
Health Care Amendments and Changes
EFF 1/1/21 Amendment
Summary of Benefits and Coverages
Summary of Benefits and Coverages
Plan D5 – Tier A
Plan D5 – Tier B & Tier C
Plan LU
COBRA Continuation Rights
Vision Benefits
Dental Benefits
Glossary of Health Coverage & Medical Terms
2023 SBC Tier A
SBC 2023 Tier B/C
SBC 2023 Tier LU
Summary Plan Description
Summary Plan Description
UFCW Midwest Health Benefit Fund SPD
Accelerated Death Benefit (ADB), Accidental Death and  Dismemberment (AD&D) Handbook
Summary of Material Modifications (SMM)
Summary of Material Modifications (SMM)
New Benefit Changes
Covid SMM
Midwest Health COVID-19 Letter
Midwest Health Pharma Changes
Newsletters
Newsletters
No Surprise Act (NSA)
NSA Additional Information
Continuity of Care (COC) Regulation