Health Care & Benefits Division

Plan Information

Wrap Plan Documents

Medical Summary of Benefits and Coverage (SBC)

Summary of Benefits and Coverage (SBC) - Effective 1/1/2023 
Summary of Benefits and Coverage (SBC) - Effective 1/1/22 - 12/31/22
Summary of Benefits and Coverage (SBC) - Effective 1/1/21 - 12/31/21
Summary of Benefits and Coverage (SBC) - Effective 1/1/20 - 12/31/20

 

Legal Notices

Legal Notices Document - Issued 12/22
Legal Notices Document - Issued 12/21
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  • Vision Summary of Benefits

  • VSP Vision Care Summary of Benefits - 1/1/23 - Coming Soon 

Medicare Prescription Drug Program Information

Navitus MedicareRx Evidence of Coverage - Effective 1/1/23
Navitus MedicareRx Summary of Benefits - Effective 1/1/23 
Navitus MedicareRx Annual Notice of Changes - Effective 1/1/23

Navitus MedicareRx Evidence of Coverage - Effective 1/1/22 - 12/31/22
Navitus MedicareRx Summary of Benefits - Effective 1/1/22 - 12/31/22
Navitus MedicareRx Annual Notice of Changes - Effective 1/1/22 - 12/31/22 

 

Life Insurance Certificates

Basic Life Insurance Certificate - Effective 1/1/23
Basic Life Insurance Certificate - Effective 1/1/22 - 12/31/22

Supplemental Life Insurance Certificate - Effective 1/1/23
Supplemental Life Insurance Certificate - Effective 1/1/22 - 12/31/22

Accidental Death and Dismemberment (AD&D) Certificate - Effective 1/1/23
Accidental Death and Dismemberment (AD&D) Certificate - Effective 1/1/22 - 12/31/22
Accidental Death and Dismemberment (AD&D) Certificate - Effective prior to 1/1/22
 
Retiree Life Insurance Certificate - Effective 1/1/22

Long Term Disability (LTD) Certificate - Effective 1/1/22
Long Term Disability (LTD) Certificate - Effective prior to 1/1/22

Life Insurance Certificate - Effective prior to 1/1/22 

 

HR/Payroll Publications

2022 ACA and the State Plan - presentation
Newly Eligible Employees - presentation

Workers' Compensation Management Bureau Publications

  • Documents related to safety and return to work can be found on the WCMB website
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HIPAA Notice

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