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Pre-Medicare Retirees Plan
Pre-Medicare Retirees Plan Documents:
CHIP Notice
COBRA
HIPAA Privacy Notice
Medicare Part D Notice
Nondiscrimination Notice
Summary of Benefits and Coverage- Standard Option
Summary of Benefits and Coverage- Enhanced Option
Pre-Medicare Retirees - Summary Plan Description and Plan Document
Summary of Material Modifications 5 2020
Summary of Material Modifications 1 2020
Summary of Material Modifications 10 2019
Summary of Material Modifications 6 2019
Summary of Material Modifications 3 2018
Summary of Material Modifications 7 2017
Summary of Material Modifications 12 2016
Schedule of Benefits- Standard Option
Schedule of Benefits- Enhanced Option
Summary Annual Report
Women’s Health and Cancer Rights Notice
Pre-Medicare Retirees Plan Forms:
Accident Form
Coordination of Benefits Form
HIPAA Release Form
HRA Reimbursement Form
Prescription Drug Reimbursement Form