2016

W-4P 2016 (Pensioners)

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

2016 Summary of Benefits

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

2016 Summary of Benefits

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

2016 Summary of Benefits

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

Self-Pay Rate Increase

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

Annual Funding Notice

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

Benefit Summary of Material Modification

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

2020

Annuity Plan Transition Brochure

Annuity Plan Transition Brochure

Annuity Summary of Material Modifications

Annuity Summary of Material Modifications

Annuity – Prudential Recordkeeper Announcement

Annuity – Prudential Recordkeeper Announcement

Benefit Summary of Material Modifications

Benefit Summary of Material Modifications

Benefit COBRA Notice Changes

Benefit COBRA Notice Changes

Pension Summary Plan Description Update

Pension Summary Plan Description

Pension Annual Funding Notice

Pension Annual Funding Notice

FFCRA Signatory Employer Notice & Declaration

FFCRA Signatory Employer Notice
FFCRA Signatory Declaration

Annuity CARES Act Loan Delay Form

Annuity CARES Act Loan Delay Form

Attention Pensioners

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

Annuity Account Inactivity Fee Notice

Federal Tax Withholding Changes for 2020

2020 Form W-4P

Non-Medicare Retiree Health Insurance Rates for 2020

Non-Medicare Retiree Health Insurance Rates for 2020

2019

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

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

ERISA Section 104(d) Notice (2018)

ERISA Section 104(d) Notice (2018)

Annuity Trust QDIA

Annuity Trust QDIA

Annuity Trust 404(a)(5) Notice

Annuity Trust 404(a)(5) Notice

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

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

2020 Benefit Plan Changes Non-Medicare Retirees Plan B

2020 Benefit Plan Changes Non-Medicare Retirees Plan B

2020 Benefit Plan Changes for Non-Retirees Plan A

2020 Benefit Plan Changes for Non-Medicare Retirees Plan A

2020 Benefit Plan Changes Active Plan Participants

2020 Benefit Plan Changes

Annuity Recordkeeper Change from MassMutual to Milliman

Annuity Recordkeeper Change from MassMutual to Milliman

Humana Medicare Opt Out Form

Humana Medicare Opt Out Form

Notice of Prescription Drug Medicare Part D

Notice of Prescription Drug Medicare Part D

Benefit Trust Summary of Material Modification

Benefit Trust Summary of Material Modification

Pension Trust Summary of Material Modification

Pension Trust Summary of Material Modification

Annuity Trust Summary of Material Modification

Annuity Trust Summary of Material Modification

Pension Plan Annual Funding Notice

New Dental Network Effective June 1, 2019

Delta Dental Announcement

2019 Anthem Medical Plan Summary of Benefits and Coverage

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

2018

2019 Adult Child Form

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

Humana Medicare Participants Rates and Opt-Out Form 2019

Medicare Part D Notice

2019 Notice of Creditable Coverage

Annuity Loan Payments 2019

Annuity Loan Payments 2019

Now Accepting Electronic Self-Pay Payments

Now Accepting Electronic Self-Pay Payments

Active and Non Medicare Participants SMM

Active and Non Medicare Participants SMM

Medicare Participants SMM

Medicare Participants SMM

Pension Trust Annual Funding Notice

Pension Trust Annual Funding Notice

Non-Medicare Retiree Rate Increase

Non Medicare -2018 Rate Increase Opt-out