Annuity Loan Summary of Material Modification

Anthem mailed new ID cards on 12/22/2021 for all active and non-Medicare plan participants effective 1/1/2022. The Group, Plan, and ID Numbers have changed. This transition is due to compliance with the No Surprises/Transparency Act as well as an eligibility platform change initiated by Anthem for our group. The benefits have not changed, but you must use the new card on and after 1/1/2022 or claims will be denied by Anthem.

You can see your new ID card at anthem.com or by using the Anthem’s Sydney Health smartphone app.

Active Participants Summary of Benefits and Coverage Plan Year 2022

Summary Annual Report – Benefit

Summary Annual Report – Annuity

Non-Medicare Retiree Plan A

Non-Medicare Retiree Plan B

Non-Medicare Retiree Rates fo r 2022

Medicare Participants Part D Notice
Medicare Rates for 2022

Annuity Trust Summary of Material Modification

Benefit Trust Summary of Material Modification

Pension Trust Summary of Material Modification

PrudentRx Flyer

Pension Trust Annual Funding Notice

Annuity Trust Summary of Material Modification

Vision Plan Change to VSP

Annuity Trust Summary Annual Report

Transition is Complete – IW Annuity Plan

Annuity Plan Transition Brochure

Annuity Summary of Material Modifications

Annuity – Prudential Recordkeeper Announcement

Benefit Summary of Material Modifications

Benefit COBRA Notice Changes

Pension Summary Plan Description

Pension Annual Funding Notice

FFCRA Signatory Employer Notice
FFCRA Signatory Declaration

Annuity CARES Act Loan Delay Form

Due to growing concerns about the spread of COVID-19 and the possibility of government mandated business closures, the Board of Trustees has authorized your April 1, 2020 pension payment to be issued March 23, 2020. This includes payments made electronically and paper checks issued.

Annuity Account Inactivity Fee Notice

2020 Form W-4P

Non-Medicare Retiree Health Insurance Rates for 2020

Annuity Trust Summary Annual Report Plan Year Ending 01-31-2019

ERISA Section 104(d) Notice (2018)

Annuity Trust QDIA

Annuity Trust 404(a)(5) Notice

Benefit Trust Summary Annual Report Plan Year Ending 01/31/2019

2020 Benefit Plan Changes Non-Medicare Retirees Plan B

2020 Benefit Plan Changes for Non-Medicare Retirees Plan A

2020 Benefit Plan Changes

Annuity Recordkeeper Change from MassMutual to Milliman

Humana Medicare Opt Out Form

Notice of Prescription Drug Medicare Part D

Benefit Trust Summary of Material Modification

Pension Trust Summary of Material Modification

Annuity Trust Summary of Material Modification

• Explanation of Required Notice
• Notice of Plan Status
• Funding Notice

Delta Dental Announcement

The Summary of Benefits and Coverage (SBC) documents from Anthem for 2019 are now available:

• Active Members Summary of Benefits and Coverage
• Metal Building Summary of Benefits and Coverage
• Retiree (Non-Medicare) Plan A Members Summary of Benefits and Coverage
• Retiree (Non-Medicare) Plan B Members Summary of Benefits and Coverage

To continue coverage in 2019 for a child aged 19 through 26, please complete the 2019 Adult Child Form .

Humana Medicare Participants Rates and Opt-Out Form 2019

2019 Notice of Creditable Coverage

Annuity Loan Payments 2019

Now Accepting Electronic Self-Pay Payments

Active and Non Medicare Participants SMM

Medicare Participants SMM

Pension Trust Annual Funding Notice

Effective June 1, 2018 the Self-Pay Rate increased from $346/month to $375/month

Non Medicare -2018 Rate Increase Opt-out

Pension Plan Annual Funding Notice, Yellow Zone Plan Status, and an Explanation of Required Notices .

Effective June 1, 2017 the Self-Pay Rate increased from $320/month to $346/month.

If you wish to change the amount of Federal Tax Withheld from your Pension, complete and return the 2017 W-4P.

For active participants in the health insurance plan, this summary details deductibles, co-pays and coinsurance.

For non-Medicare retirees who elected health Plan A, this summary details deductibles, co-pays and coinsurance.

For non-Medicare retirees who elected health Plan B, this summary details deductibles, co-pays and coinsurance.

Summary of Material Modifications made to the Benefit Summary Plan Description.

If you wish to change the amount of Federal Tax Withheld from your Pension, complete and return the 2016 W-4P.

For active participants in the health insurance plan, this summary details deductibles, co-pays and coinsurance

For non-Medicare retirees who elected health Plan A, this summary details deductibles, co-pays and coinsurance.

For non-Medicare retirees who elected health Plan B, this summary details deductibles, co-pays and coinsurance.

Please read the Notice of Non-Discrimination Rule Section 1557 of the Affordable Care Act

Pension Plan Annual Funding Notice, Yellow Zone Plan Status, and an Explanation of Required Notices

Effective June 1, 2016 the Self-Pay Rate increased from $297/month to $320/month