Forms and Documents

Your Benefits During COVID-19

• Coronavirus Flyer

General

• Overview Brochure
• Enrollment Form
• HMO Summary of Benefits and Coverage – effective March 1, 2024
• PPO Summary of Benefits and Coverage – effective January 1, 2024
• HPN HMO Discover Guide
• Vision Benefit Summary
• Disability Claim Form
• LiveHealth Online Flyer
• NowClinic Telemedicine Flyer
• Be Smart…Don’t Overpay for Urgent Care
• Notice of Privacy Practices
• HIPAA Privacy Notice

Newsletters

• Spring 2025 Newsletter
• Winter 2025 Newsletter
• Fall 2024 Newsletter
• Summer 2024 Newsletter
• Spring 2024 Newsletter
• Winter 2023 Newsletter
• Fall 2023 Newsletter

Summary Plan Description and Amendments

• Summary Plan Description

Required Notices

• No Surprises Act Notice 2023
• Teamsters Local 986 2022 Dependent Audit FAQs-v2.pdf