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Vision and Hearing

Amplifon Hearing Program – Effective 7/1/2020

Low Vision Benefit

EyeMed Benefit Summary – Effective 7/1/2020

Eye Med – FAQ’s

EyeMed – Mobile App – How to Use

Freedom Pass Special Savings Program

Out-of-Network Vision Claim Form

Health & Welfare

ACH Authorization / Direct Deposit Form

ACH Authorization / Direct Deposit (WRITABLE)

Change of Address Form

COBRA Initial Notification of Rights

Dialysis Benefit Brochure

Email Opt In Form – November 2012

Enrollment Form/Spousal Affidavit

Application for Surviving Spouse

HIPAA Authorization Form

Insurance Reimbursement Claim Form – September 2012

Non-Discrimination Notice

Other Insurance Accident/Illness Form – May 2013

Out of Network Case Management Protocols

SupportLinc Flyer

Surviving Spouse Waiver of Insurance

Policy for Spouses with Other Health Coverage

Your Privacy Rights Under HIPAA

Suicide Prevention

I Am Mentally Healthy

It’s Okay to Feel

How to Help a Coworker in Distress

Suicide Prevention in the Workplace for Managers

Suicide Prevention in the Workplace

Summary Plan Description

Summary of Benefits Brochure – Active Plan

Summary of Benefits Brochure – Base Plan

Summary of Benefits and Coverage – Plan A (Actives) – July 2020

Summary of Benefits and Coverage – Plan B (Base Benefits) – July 2020

Summary of Benefits and Coverage – Plan M (Medicare Supplement) – July 2020

Summary of Benefits and Coverage – Plan R (Early Retirees) – July 2020

Summary Plan Description for Plans A, B, R, & M – January 2020