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Dental

Delta Dental PPO Certificate

Summary of All Plans

Benefits at a Glance – Actives Plan

Benefits at a Glance – Base Plan (April 27, 2020)

Benefits at a Glance – Retiree Plan

Delta Dental and Orthodontics

Delta Dental GRIN

Disability

Authorization For Release of Information to Local 8

Authorization For Release of Information Form

Total & Permanent Disability Application

Short Term Disability Claim Packet

Disability Short Term & Permanent Brochure

Definition of Total and Permanent Disability

Life Insurance

Summary of Coverage for Active Members – December 2008

Beneficiary Designation Form

Group Term Life Benefit Certificate – January 2017

Rx/Prescription Drug Coverage

Express Scripts Pharmacy Mail Order Form

Accredo-Express Script Specialty Pharmacy Brochure

Accredo Specialty Drug List

Express Scripts Preferred Rx and Exclusion List

Express Scripts Rx Reimbursement Form

Express Scripts Formulary Exclusion List Changes – April 1, 2021

Express Scripts Formulary Exclusion List Changes – July 1, 2021

Summary of Material Modifications RX  – September 2020

Summary of Material Modification Effective 6/1/2018

Prescription Benefit Change Effective November 2020

Summary Annual Reports

2019 Health Plan Summary Annual Report

2018 Health Plan Summary Annual Report

2017 Health Plan Summary Annual Report

2016 Health Plan Summary Annual ReportExpress Scripts Formulary Exclusion List Changes – April 1, 2021

2015 Health Plan Summary Annual Report

2014 Health Plan Summary Annual Report