You can download the current Contract by clicking on the links below:

2022-23 Dental Plan DHMO

( 840.49 KB)

2022-23 Dental Plan PPO High

( 941.33 KB)

2022-23 Dental Plan PPO Low

( 958.87 KB)

2022-23 PPO Dental Summary Plan Description

( 1248.70 KB)

2023 HIPAA OPT-OUT NOTICE

( 229.94 KB)

2023 Medical Plan

( 2303.74 KB)

2023 Medical Summary Plan Description

( 322.05 KB)

Accident, Critical Illness and Hospital Insurance

( 1325.07 KB)

CRITERIA FOR WEIGHT LOSS INJECTABLE MEDS

( 325.74 KB)

EAP Provider List

( 757.85 KB)

EAP Provider List

( 757.85 KB)

Group Accident Insurance Certificate

( 577.44 KB)

Group Critical Illness Certificate

( 502.14 KB)

Group Hosp Indemnity Certificate

( 457.18 KB)

Humana Vision Plan

( 2421.99 KB)

List of Lab Tests Performed in Wellness Center Laboratory

( 86.42 KB)

List of Medications from Wellness Center

( 1167.27 KB)

New Health Insurance Marketplace Coverage Notice

( 269.70 KB)

Notice of Privacy Practices

( 47.75 KB)

Recommended Annual Health Guidelines

( 640.95 KB)

RSL Bereavement Support Services

( 334.07 KB)

RSL Group Life (Vol Term)

( 552.17 KB)

RSL Group Life Insurance (Employer Paid)

( 101.48 KB)

SavRx Mail Order Form

( 433.80 KB)

SavRx Medication Formulary List

( 3057.30 KB)

Transparency in Coverage

( 344.27 KB)

Weight Loss Program (prescription)

( 325.74 KB)

Wellness Center Services

( 134.27 KB)

Last updated: Jan. 12, 2023

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