Documents & Forms Documents This is hidden Medical/Prescription Gold & Platinum SPD and Plan Document Platinum Plus SPD and Plan Document Participating Pharmacy Directory Prescription Drug Formulary 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 Summary Annual Report Your Rights and Protections Against Surprise Medical Bills Notice of Privacy Practices Dental 2025 Gold & Platinum Indemnity Dental Schedule 2025 Platinum Plus Indemnity Dental Schedule United Concordia DHMO user guide This is hidden Drug Pension and Retiree Medical DRUG PENSION 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 Summary Plan Description Summaries of Material Modifications2012 Summary of Material Modifications 2024 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