Forms & Notices
Make sure you understand important Plan information and forms
The Trust Fund does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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Medical
Spring Health Employee Assistance Program Overview
2024 Blue Cross – Smart Choices APPO Plan
2024 Blue Cross – PPO Plan
2024 Blue Cross – Retiree PPO Plan
2024 Kaiser – Smart Choices HMO Plan
2024 Kaiser – DHMO Plan
2024 Kaiser – Non-Medicare Retiree HMO Plan
Kaiser Permanente – Helping you stay Covered
Kaiser Permanente – Ayudándole a mantenerse cubierto
Notice of Privacy Practices
Important Information about the Smart Choices/Healthy Rewards Program
Enrollment Booklet: Use this form to enroll, change your name, address, plan, marital status, dependent(s).
Smart Choices Instructions
Kaiser Instructions on Completing an Online or In-Person Health Education Course
MedExpert QMMS Web Portal Access Instructions
VSP 60% Savings on Digital Hearing Aids
2019 Indemnity PPO Medical Plan Preventative Care Guidelines
VSP Individual Visions Plans for Retirees
Dental
Enrollment Booklet: Use this form to enroll, change your name, address, plan, marital status, dependent(s).
Print Delta Dental ID Cards and Go Paperless
Flyer – Exam and Cleaning
Flyer – Implants
Prescription Drugs
Change in Prescription Drug Provider Effective January 1, 2023
WellDyneRX – WellView Member Portal & Cost Calculator Tool
WellDyneRX 2019 Clinical Focus Formulary (English)
WellDyneRX 2019 Clinical Focus Formulary (Spanish)
Medicare Part D Notice of Creditable Coverage
WellDyneRx Prescription Delivery Service Terms
WellDyneRx Prescription Delivery Service Form
WellDyneRx Free OneTouch Glucose Meter
General Forms
Rates
General Notices
2023 Notice of Creditable Coverage
2022 Notice of Creditable Coverage
February 2022 – New Paid Maternity Leave Program
January 2022 – Your Rights & Protection Against Surprise Medical Bills
2021 Summary Annual Report
2020 Summary Annual Report
2019 Summary Annual Report
2016 Summary Annual Report
Outpatient Procedures & Coverage for Gene Therapies
2019 Notice of Creditable Coverage