Forms and information
Call us at 855-405-3863 if you need help with these forms.
Get to know your benefits. It will help you know what is available to you. To find out about your benefits, call us at 855-405-3863, or download a copy of your Participant Guide.
Benefits at a glance
View your Benefits at a Glance:
Summary Annual Report
Download a copy of your Summary Annual Report (SAR).
Summary of Benefits and Coverage
Download a copy of your Summary of Benefits and Coverage (SBC). It gives you a quick outline of some of your benefits and costs.
- Effective January 1, 2023
Summary Plan Description
View your Summary Plan Description (SPD). It explains all of your benefits.
Summary of Material Modifications
After each SPD is published, certain changes may have been made to your benefits. These changes are reflected in a Summary of Material Modifications (SMM).
Evidence of coverage
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory (outpatient) surgical center, you are protected from “surprise billing” or “balance billing.” More information