Plan Documents:
Summary Plan Description (“SPD”) + Summary of Material Modifications (“SMM”):
The SPD summarizes the key provisions of the Plan and includes important information about your
benefits from the Plan. The SPD is updated from time-to-time and therefore includes additional
information and changes to the Plan in the form of a SMM.
DOWNLOAD SPD
DOWNLOAD SMM
Summary of Benefits and Coverage (“SBC”):
This document provides you with a quick reference to covered expenses, deductibles and out-of pocket costs.
This is not a full explanation of the benefits covered by the Plan. For more information about the benefits
covered by the Plan, see the enclosed Summary Plan Description and Benefit Alerts.
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SMM Notice to Plan Participants RE Telehealth Preventive Services Sex Transformation 09_22_20:
This document provides you information on changes to the Plan in the form of a Summary Material Modification (SMM).
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SMM Notice to Plan Participants RE Increases to Deductible, OOP, and Life AD&D Benefit 12_29_2022:
This document provides you information on changes to the Plan in the form of a Summary Material Modification (SMM).
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Important Notifications:
Notice of Privacy Practices:
This document provides you with a quick reference to covered expenses, deductibles and out-of pocket costs.
This is not a full explanation of the benefits covered by the Plan. For more information about the benefits
covered by the Plan, see the enclosed Summary Plan Description and Benefit Alerts.
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Women’s Health and Cancer Rights Act Notice:
This notice includes important information about protections for individuals who elect breast
reconstruction in connection with a mastectomy. You will also receive this notice, annually, via US Mail.
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Summary Annual Report:
The Summary Annual Report provides insurance and basic financial information regarding the Plan and informs you of your rights to additional information.
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