Monday, December 22, 2014

Sheet Metal Workers Union Local 162

Member Fringe Benefit Website

Health Care Information

Please use the site menu to navigate to detailed information on the summary plan description. For general health related frequently asked questions (FAQs) and links, please see information on this page! 

If you have any questions or would like clarification, you can request additional information by calling the Benefit Fund Office. Your question may be referred to the Board of Trustees.



Health Care Links  Health Care Links

  
Health Care Documents - Mailings  Health Care Documents - Mailings
 Title 
Envision Pharmacy Claim FormDownload
Envision Pharmacy Coordination of Benefits Download
Medical Claim Form Download
Medical Claim Form - Disability Download
VSP - Out of Network Claim FormDownload
Enrollment Form for Schedule 1ADownload
HIPAA Privacy Instructions and Form Download
Address Verification Change Form Download
Summary Annual Report 2008Download
Summary Annual Report 2009Download
Women’s Health & Cancer-Rights Act NotificationDownload
SMM - Coordination of Benefits with HMODownload
Appeals Procedure Changes 2009Download
Schedule 1, 1A, & 7: Summary Material Modification July 2010Download
Schedule 2 & 4: Summary Material Modification July 2010Download
Enrollment Form to Add Dependents Age 19-25 Eff 1/2011Download
Health Care Reform Plan Changes Eff 1/1/2011Download
HRA (Health Reimbursement Arrangement) SMMDownload
HRA Claim FormDownload
HRA Eligible ExpensesDownload
Annual Coordination of Benefits Mailing 2011Download
Medicare Creditable Coverage Notice - 2011Download
Kaiser Chiropractic InfoDownload
Summary Annual Report 2010Download
Bright Now Dental Benefit & Enrollment InfoDownload
Schedule 1, 1A, & 7: Summary Material Modification July 2012Download
Schedule 2 & 4: Summary Material Modification July 2012Download
Women’s Health And Cancer Rights Act Notification-2012 Download
Summary Annual Report 2011Download
Medicare Creditable Coverage Notice - 2012Download
Enrollment Form for Schedule 2Download
Blue Shield Reimbursement FormDownload
Privacy Practices Notice -- 2013Download
Summary of Benefits and Coverage - Delta DentalDownload
Summary of Benefits and Coverage - Blue Shield - Schedule 1 Download
Summary of Benefits and Coverage - Blue Shield - Schedule 1ADownload
Summary of Benefits and Coverage - Blue Shield - Schedule 2Download
Summary of Benefits and Coverage - Kaiser - ActivesDownload
Summary of Benefits and Coverage - Kaiser - ProductionDownload
Summary of Benefits and Coverage - Kaiser - RetireesDownload
Women's Health and Cancer Rights Act Notification - 2013Download
Medicare Creditable Coverage Notice - 2013Download
Summary Annual Report 2012Download
TARP - Navigating the Road to Alcohol and Drug TreatmentDownload
2014 Notice of Creditable CoverageDownload
2014 Women's Health & Cancer Rights, Newborns & Mothers Health Protection and Privacy NoticeDownload
2014 Privacy Practices NoticeDownload
2014 Blue Shield Nurseline FlyerDownload
Summary Annual Report for Plan Year End 12/31/13 - Nov. 2014Download

  
Health Care FAQs  Health Care FAQs




























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