Wednesday, April 23, 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  Health Care Documents
 Title 
Address Verification Change Form Download
Annual Coordination of Benefits Mailing 2011Download
Appeals Procedure Changes 2009Download
Blue Shield Reimbursement FormDownload
Bright Now Dental Benefit & Enrollment InfoDownload
Enrollment Form for Schedule 1ADownload
Enrollment Form for Schedule 2Download
Enrollment Form to Add Dependents Age 19-25 Eff 1/2011Download
Envision Pharmacy Claim FormDownload
Envision Pharmacy Coordination of Benefits Download
Health Care Reform Plan Changes Eff 1/1/2011Download
HIPAA Privacy Instructions and Form Download
HRA (Health Reimbursement Arrangement) SMMDownload
HRA Claim FormDownload
HRA Eligible ExpensesDownload
Kaiser Chiropractic InfoDownload
Medical Claim Form Download
Medical Claim Form - Disability Download
Medicare Creditable Coverage Notice - 2011Download
Medicare Creditable Coverage Notice - 2012Download
Medicare Creditable Coverage Notice - 2013Download
Privacy Practices Notice -- 2013Download
Schedule 1, 1A, & 7: Summary Material Modification July 2010Download
Schedule 1, 1A, & 7: Summary Material Modification July 2012Download
Schedule 2 & 4: Summary Material Modification July 2010Download
Schedule 2 & 4: Summary Material Modification July 2012Download
SMM - Coordination of Benefits with HMODownload
Summary Annual Report 2008Download
Summary Annual Report 2009Download
Summary Annual Report 2010Download
Summary Annual Report 2011Download
Summary Annual Report 2012Download
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 - Delta DentalDownload
Summary of Benefits and Coverage - Kaiser - ActivesDownload
Summary of Benefits and Coverage - Kaiser - ProductionDownload
Summary of Benefits and Coverage - Kaiser - RetireesDownload
VSP - Out of Network Claim FormDownload
Women’s Health & Cancer-Rights Act NotificationDownload
Women’s Health And Cancer Rights Act Notification-2012 Download
Women's Health and Cancer Rights Act Notification - 2013Download

  
Health Care FAQs  Health Care FAQs




























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