Documents & Forms Documents This is hidden Medical/Prescription Participating Pharmacy Directory Prescription Drug Formulary Indemnity Plan – Preventive Care Guidelines Self-Payment Instruction Flyer Comparison Summaries2024 Platinum & Gold Plans2024 Platinum Plus Plan Summaries of Benefits and CoverageAnthem Indemnity Medical GoldAnthem Indemnity Medical PlatinumAnthem Indemnity Medical Platinum Plus Kaiser GoldKaiser PlatinumKaiser Platinum PlusKaiser Employees UHC GoldUHC Harmony/Alliance GoldUHC Harmony/Alliance PlatinumUHC PlatinumUHC Platinum Plus SMMs and Plan Notices2024 Prescription Update, HMO Enrollees2024 Indemnity Prescription/EAP Update2024 Behavioral Health Coverage2024 UHC Changes2023 COVID Public Emergency End2022 Platinum & Gold Changes Summary Annual Report Your Rights and Protections Against Surprise Medical Bills Notice of Privacy Practices Dental 2024 Gold & Platinum Indemnity Dental Schedule 2024 Platinum Plus Indemnity Dental Schedule United Concordia DHMO user guide This is hidden Drug Pension and Retiree Medical DRUG PENSIONSummary Plan DescriptionSuspension PamphletAnnual Funding NoticeNotice of Critical Status RETIREE MEDICALSummaries of Material Modifications2024 Behavioral Health Change2024 UHC Changes2023 COVID Public Emergency End2015 Retiree Death Benefit Other Retiree Medical DocumentsRetiree Plan Comparison SummaryPreferred Pharmacy Directory General Sales Pension Summary Plan Description Summaries of Material Modifications2012 Summary of Material Modifications 2023 Annual Funding Notice Forms This is hidden Medical/Prescription Claim FormsMedical ClaimPrescription Reimbursement Claim FormVision Claim Enrollment FormsGold and Platinum EnrollmentPlatinum Plus EnrollmentKaiser EnrollmentUnited Healthcare Enrollment Other FormsAppeal FormAuthorized Representative FormBeneficiary DesignationChange of AddressAffidavit of Health Care CoveragePHI AuthorizationStudent Certification Dental Statement of Orthodontic Services This is hidden Drug Pension and Retiree Medical DRUG PENSIONPension Application Direct Deposit Form W-4P (Federal Tax Withholding) DE-4P (California Tax Withholding) Change of Address Employment Questionnaire Appeal Form RETIREE MEDICALDrug Pension Medical Deduction Authorization General Sales Medical Deduction Authorization General Sales Pension Pension Application Direct Deposit Form W-4P (Federal Tax Withholding) DE-4P (California Tax Withholding) Change of Address Employment Questionnaire Appeal Form
