American Rescue Plan Act of 2021
Temporary COBRA Premium Assistance
Benefit Overviews
2023 Summary of Benefits and Coverage (SBC)
2023 Active Health Benefit Summary
2023 Retiree Health Benefit Summary
Health Insurance Coverage Outside of the United States - January 2015
Glossary of Health Coverage and Medical Terms - September 2017
Claims
Davis Vision Claim Form
Delta Dental Claim Form
Disability Claim Form
EmpiRx Prescripton Claim Form
Medical Claim Form
Other Insurance Information Form
Dental
Delta Dental Claim Form
Delta Dental Claim Payment Notice
Disability
Disability Claim Form
Hearing
Epic Hearing Benefit Summary - January 2023
Health Care Reform / Affordable Care Act
ACA Reporting Information for Employers
Affordable Care Act Requirement - Social Security Numbers Needed - July 2015
ACA Notice to Members - September 2013
ACA Notice to Employers - September 2013
Marketplace Form - Excavating, Grading and Asphalt Welfare - September 2013
Marketplace Form - Garage Attendants, Linen & Laundry Welfare - September 2013
Marketplace Form - Private Scavengers Welfare - September 2013
Legal Notices
Women's Cancer Act Notice - December 2022
Medicare Part D Notice
Privacy Permission Form for Family Members
BCBS Compliance Notice
Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)
COBRA Act of 1985
Family and Medical Leave Act Notice
Genetic Information Nondiscrimination Act (GINA)
Mental Health Parity Act
Privacy Notice
Qualified Medical Child Support Order Procedures
Statement of ERISA Rights
Newborns and Mothers Health Protection Act
Womens' Health and Cancer Rights Act
Member Assistance Program (MAP)
Member Assistance Program Flyer - November 2023
Member Assistance Program Flyer - July 2020
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Notices
2023 Fall Wellness Event - Announcement - September 2023
2023 Fall Wellness Event - Optional Tests - September 2023
Summary of Material Modifications - Hinge Health - July 2023
Summary of Material Modifications - COVID Change - May 2023
Summary of Material Modifications
- Out of Pocket Wellness Reminder - December 2022
Summary of Material Modifications - OTC Covid Tests - January 2022
Summary of Material Modifications - Rx Copay Changes - January 2022
Summary of Material Modifications - OOP Wellness Reminder - December 2021
Summary of Material Modifications - Wellness Program - September 2021
Summary of Material Modifications - September 2021
Summary of Material Modifications - May 2021
Illinois COVID-19 Vaccine Update - January 2021
Summary of Material Modifications - December 2020
Flu Shot Notice - October 2020
Viveka Mobile App Announcement - July 2020
COVID-19 Coverage Announcement - May 2020
Health Plan Improvement - December 2019
Summary of Material Modifications - December 2019
"Building Bridges to Health"
Health Fair - August 2019
Summary of Material Modifications - December 2018
New Prescription Drug Provider Effective February 1, 2018
Summary of Material Modifications - October 2018
Summary of Material Modifications - September 2017
Summary of Material Modifications - February 2017 (Updated 8/11/17)
Health Plan Improvements - November 2015
Health Plan Improvements - Diabetes Benefit - July 2014
Health Plan Improvements - December 2013
New Diagnostic Imaging Network - October 2013
Health Plan Improvements - May 2013
Summary of Material Modifications - June 2010
Other
Privacy Permission Form for Family Members
Benefit Provider Contact Information - November 2020
Address Change Form
Physical Therapy
Hinge Health Flyer
Prescription/Rx
At-Home COVID Test Reimbursement Form - January 2022
Over-the-Counter COVID Test Information - January 2022
EmpiRx Direct Member Reimbursement Form - January 2022
New Prescription Drug Provider Effective October 1, 2020 - October 2020
EmpiRx Processing Information - October 2020
EmpiRx Brochure - October 2020
EmpiRx Personal Representative Form - October 2020
EmpiRx Mail Order Form - October 2020
EmpiRx FAQs - October 2020
Radiology
Future Diagnostics Flyer - October 2021
Absolute Solutions Member Flyer - July 2020
Sleep Apnea
Sleep Apnea Equipment & Supplies - January 2015
Summary Plan Descriptions (SPD)
If you are unsure which Welfare Plan you belong to, please contact the Fund Office at (630) 887-4150
Summary Plan Description (SPD) – Excavating, Grading and Asphalt Welfare - June 2016
Summary Plan Description (SPD) – Garage Attendants, Linen & laundry Welfare - June 2016
Summary Plan Description (SPD) – Private Scavengers Welfare - June 2016
Vision
Davis Vision Announcement
Davis Vision Flier
Davis Vision Claim Form
Wellness Program
2023 Fall Wellness Event - Announcement - September 2023
2023 Fall Wellness Event - Optional Tests - September 2023
Summary of Material Modifications - Wellness Program - September 2021
Wellness Program Explained - February 2021
Health Spending Account Reimbursement Form
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