Summary of Benefits

Summary of Benefits and Coverage (ACA) Effective : 01/01/2025 To 12/31/2025 (pdf)

Summary of Benefits and Coverage (ACA) Effective : 01/01/2024 To 12/31/2024 (pdf)

Summary of Benefits and Coverage (ACA) Effective : 01/01/2023 To 12/31/2023 (pdf)

Summary of Benefits and Coverage (ACA) Effective : 01/01/2022 To 12/31/2022 (pdf)

Glossary and Medical Terms (ACA) (pdf)

Vision Benefits for Active Participants (pdf)

Dental Benefits for Active Participants (pdf)

Outpatient Diagnostic Testing Warning (pdf)

Pre-Certification (pdf)

Notice of Privacy Practices (pdf)

Summary of Benefits for Retirees Not Eligible for Medicare Effective : 01/01/2023 To 12/31/2023 (pdf)

Summary of Benefits for Retirees Not Eligible for Medicare Effective : 01/01/2022 To 12/31/2022 (pdf)

Dental Benefits for Retirees Not Eligible for Medicare (pdf)

Vision Benefits for Retirees Not Eligible for Medicare (pdf)

Outpatient Diagnostic Testing Warning (pdf)

Pre-Certification (pdf)

Notice of Privacy Practices (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2023 To 12/31/2023 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2022 To 12/31/2022 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2021 To 12/31/2021 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2020 To 12/31/2020 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2019 To 12/31/2019 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2018 To 12/31/2018 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2017 To 12/31/2017 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2016 To 12/31/2016 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2015 To 12/31/2015 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2014 To 12/31/2014 (pdf)

Summary of Benefits for Retirees Eligible for Medicare Effective : 01/01/2013 To 12/31/2013 (pdf)

Summary Pamphlet for Retirees Eligible for Medicare (pdf)

Dental Benefits for Retirees Eligible for Medicare (pdf)

Vision Benefits for Retirees Eligible for Medicare (pdf)

Notice of Privacy Practices (pdf)