Plan Documents

Main Plan - SPD (Summary Plan Description)

Sub-Plans - SPD (Summary Plan Description)

 

Plan SBC's

Main Plan - SBC 2023-2024

Sub-Plan B1 - SBC 2023-2024

Sub-Plan B2 - SBC 2023-2024

 

Fillable Forms

Enrollment Form

ACH_Debit_Authorization_Form

ACH Agreement Form

Claim Form

Disability Claim Form

Application for Retiree Health Coverage

Subrogation Form

VSP Participant Reimbursement Form

Sav-Rx Eligibility Amendment Form

Medicare Advantage Election Form

Appointment of Auth. Rep- HIPAA

HRA Claim Form

Accident Questionnaire

 

Mailings & Updates

Delta Dental 2023 Update

Delta Dental BrushSmart

Delta Dental Mobile App

Delta Dental Preventive Care Reminder

Hearing Aid Benefit Improvement

Mental Health Wallet Card

NSA Surprise Billing Notice

OTC Covid Testing Announcement

Sav-Rx Patient Portal

Teladoc_flyer

VSP ID Card Sample