Documents & Forms
Documents
This is hidden
Medical/Prescription
Platinum Plus SPD and Plan Document
Participating Pharmacy Directory
Indemnity Plan – Preventive Care Guidelines
Self-Payment Instruction Flyer
Benefit Guides
2025 Platinum and Gold
2025 Platinum Plus
2025 Retiree
Summaries of Benefits and Coverage
Anthem Indemnity Medical Gold
Anthem Indemnity Medical Platinum
Anthem Indemnity Medical Platinum Plus
Kaiser Gold
Kaiser Platinum
Kaiser Platinum Plus
Kaiser Employees
UHC Gold
UHC Harmony/Alliance Gold
UHC Harmony/Alliance Platinum
UHC Platinum
UHC Platinum Plus
SMMs and Plan Notices
2024 Prescription Update, HMO Enrollees
2024 Indemnity Prescription/EAP Update
2024 Behavioral Health Coverage
2024 UHC Changes
2023 COVID Public Emergency End
2022 Platinum & Gold Changes
This is hidden
Medical/Prescription
Platinum Plus SPD and Plan Document
Participating Pharmacy Directory
Indemnity Plan – Preventive Care Guidelines
Self-Payment Instruction Flyer
Benefit Guides
2025 Platinum and Gold
2025 Platinum Plus
2025 Retiree
Summaries of Benefits and Coverage
Anthem Indemnity Medical Gold
Anthem Indemnity Medical Platinum
Anthem Indemnity Medical Platinum Plus
Kaiser Gold
Kaiser Platinum
Kaiser Platinum Plus
Kaiser Employees
UHC Gold
UHC Harmony/Alliance Gold
UHC Harmony/Alliance Platinum
UHC Platinum
UHC Platinum Plus
SMMs and Plan Notices
2024 Prescription Update, HMO Enrollees
2024 Indemnity Prescription/EAP Update
2024 Behavioral Health Coverage
2024 UHC Changes
2023 COVID Public Emergency End
2022 Platinum & Gold Changes
This is hidden
Drug Pension and Retiree Medical
Summary Plan Description
Suspension Pamphlet
Annual Funding Notice
Notice of Critical Status
RETIREE MEDICAL
Summaries of Material Modifications
2024 Behavioral Health Change
2024 UHC Changes
2023 COVID Public Emergency End
2015 Retiree Death Benefit
Other Retiree Medical Documents
2025 Retiree Benefits Guide
Preferred Pharmacy Directory
General Sales Pension
Summaries of Material Modifications
2012 Summary of Material Modifications
Forms
This is hidden
Medical/Prescription
Claim Forms
Medical Claim
Prescription Reimbursement Claim Form
Vision Claim
Enrollment Forms
Gold and Platinum Enrollment
Platinum Plus Enrollment
Kaiser Enrollment
United Healthcare Enrollment
Other Forms
Appeal Form
Authorized Representative Form
Beneficiary Designation
Change of Address
Affidavit of Health Care Coverage
PHI Authorization
Student Certification