Participant Forms                                      

• Benefit Claim Form 2025
• Benefit Claim Form Retro 2024 Pre-Tax Premiums
  
• Pub. 502 - IRS Medical & Dental Expenses
• Participant Data Form

Plan Documents                                        

• Summary Plan Description
• Plan Document
• Trust Agreement
• Summary Annual Report

 

Notices                                                                                              

• Notice of Privacy Practices
• Notice of Benefit Amount Increase; July 2021
• Notice of Prohibition on Pre-Tax Premium Reimbursement; January 2023
• Notice of Benefit Amount Increase; July 2024
• Notice of Monthly Proof of Premium for 2025 plan year
• Notice of Annual Verification of Recurring Premiums 2025
• Notice of Summary of Materials Modification SMM - Taxable Benefits Pre-Tax Premiums
• Notice of Monthly Verification, Increase Benefit Amount, Taxable Benefits