Forms and Notices

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Dental

Dental News Bulletin - June 18, 2007

Disability

Authorization For Release of Information to Local 8

Authorization For Release of Information Form

Total & Permanent Disability Application

Short Term Disability Claim Form

Disability Short Term & Permanent Brochure

Definition of Total and Permanent Disability

Life Insurance

Summary of Coverage for Active Members - December 2008

Beneficiary Designation Form

Group Term Life Benefit Certificate - January 2017

Rx/Prescription Drug Coverage

MedTipster FAQ

MedTipster Brochure

Envisionmail Brochure

Envisionmail Enrollment Form for Mail Service

Envision Specialty Brochure Mail Service (Chronic & Complex Conditions)

Summary Annual Reports

2016 Health Plan Summary Annual Report

2015 Health Plan Summary Annual Report

2014 Health Plan Summary Annual Report

2013 Health Plan Summary Annual Report

2012 Health Plan Summary Annual Report

2011 Health Plan Summary Annual Report

2010 Health Plan Summary Annual Report

2009 Health Plan Summary Annual Report

2008 Health Plan Summary Annual Report

2007 Health Plan Summary Annual Report

2006 Health Plan Summary Annual Report

2005 Health Plan Summary Annual Report

2004 Health Plan Summary Annual Report

Vision and Hearing

TruHearing Program - September 2014

Diabetic Eye Care Program

Vision Sevice Plan Benefits Summary - August 2013

Vision Service Plan Claim Form

Health & Welfare

ACH Authorization / Direct Deposit Form

Change of Address Form

COBRA Election to Continue Coverage

COBRA Initial Notification of Rights

Dialysis Benefit Brochure

Email Opt In Form - November 2012

Enrollment Form

Health Application for Surviving Spouse

HIPAA Authorization Form

Insurance Reimbursement Claim Form - September 2012

Non-Discrimination Notice

Other Insurance Accident/Illness Form - May 2013

SupportLinc Flyer

Policy for Spouses with Other Health Coverage

Summary of Benefits Brochure

Summary of Material Modification -- September 2016

Your Privacy Rights Under HIPAA

Summary Plan Description

Summary of Benefits and Coverage - Plan A (Actives) - January 2018

Summary of Benefits and Coverage - Plan B (Base Benefits) - January 2018

Summary of Benefits and Coverage - Plan R (Early Retirees) - January 2018

Summary of Benefits and Coverage - Plan M (Medicare Supplement) - January 2018

Summary of Benefits and Coverage for Active Members January 2017

Summary of Benefits and Coverage for Base Plan Members January 2017

SPD for Actives Plan A January 2016

SPD for Base Benefit Plan B January 2016

Summary of Benefits and Coverage for Active Members - January 2016

Summary of Benefits and Coverage for Base Plan Members - January 2016

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