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.

2023

Summary Annual Report – Annuity

Summary Annual Report – Annuity

Summary Annual Report – Benefit

Summary Annual Report – Benefit

ERISA Section 204(d) Notice

ERISA Section 204(d) Notice

Insurance Change to Aetna for Active Participants and Non-Medicare Retirees Eff 1/1/2024

Insurance Change to Aetna for Active Participants and Non-Medicare Retirees Eff 1/1/2024

2024 Non-Medicare Retiree Rates and Wellness Incentive

2024 Non-Medicare Retiree Rates and Wellness Incentive

HRA Suspension & 2024 Self-Payment Rate Change

HRA Suspension & 2024 Self-Payment Rate Change

Medicare Advantage Plan Adds Dental & Vision for 2024

Medicare Advantage Plan Adds Dental & Vision for 2024

Benefit Eligibility Change

Benefit Eligibility Change

Pension Plan Annual Funding Notice

Pension Annual Funding Notice

Annuity Plan SECURE Act 2.0

Annuity Plan SECURE Act 2.0

Pension Plan SECURE Act 2.0

Pension Plan SECURE Act 2.0

Annuity Inactivity Fee

Annuity Inactivity Fee

Non-Medicare Retiree Incentive

Non-Medicare Retiree Incentive

2022

Pension Trust 204(h) Notice and Summary of Material Modifications

Pension Trust 204(h) Notice and Summary of Material Modifications

2023 Active Plan Changes/SurgeryPlus/SBC/DOL Online Security Tips

2023 Active Plan Changes/SurgeryPlus/SBC/DOL Online Security Tips

2023 Non-Medicare Rates/SurgeryPlus/SBC’s/DOL Online Security Tips

2023 Non-Medicare Rates/SurgeryPlus/SBC’s/DOL Online Security Tips

2023 Medicare Rate/Medicare Part D Notice/DOL Online Security Tips

2023 Medicare Rate/Medicare Part D Notice/DOL Online Security Tips

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

PrePaid Focus Program Mailing Pensioners/Disability

PrePaid Focus Program Mailing Pensioners/Disability

Self-Pay Through Member Dashboard

Self-Pay Through Member Dashboard

Non-Medicare Retiree Incentive

Non-Medicare Retiree Incentive

Weekly Disability Benefit

Weekly Disability Benefit

Pension Annual Funding Notice

Pension Annual Funding Notice

Annuity 404(a) Notice

Annuity 404(a) Notice

Benefit: Your Rights and Protections Against Surprise Medical Bills

Benefit: Your Rights and Protections Against Surprise Medical Bills

Annuity Loan Summary of Material Modification

Annuity Loan Summary of Material Modification

2021

Anthem mailed new ID cards on 12/22/2021

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.

ERISA Section104(d) Notice

ERISA Section104(d) Notice

Active Participants Summary of Benefits and Coverage Plan Year 2022

Active Participants Summary of Benefits and Coverage Plan Year 2022

Summary Annual Report – Benefit

Summary Annual Report – Benefit

Summary Annual Report – Annuity

Summary Annual Report – Annuity

Summary of Benefits and Coverage for 2022

Non-Medicare Retiree Plan A

Non-Medicare Retiree Plan B

Non-Medicare Retiree Rates for 2022

Non-Medicare Retiree Rates fo r 2022

Medicare Participants Part D Notice and Medicare Rates for 2022

Medicare Participants Part D Notice
Medicare Rates for 2022

Medicare Part D Notice

Medicare Part D Notice

Annuity Trust Summary of Material Modification

Annuity Trust Summary of Material Modification

Benefit Trust Summary of Material Modification

Benefit Trust Summary of Material Modification

Pension Trust Summary of Material Modification

Pension Trust Summary of Material Modification

Introducing PrudentRx

PrudentRx Flyer

Pension Trust Annual Funding Notice

Pension Trust Annual Funding Notice

Annuity Trust Summary of Material Modification

Annuity Trust Summary of Material Modification

2020

Vision Plan Change to VSP

Vision Plan Change to VSP

Annuity Trust Summary Annual Report

Annuity Trust Summary Annual Report

Transition is Complete – IW Annuity Plan

Transition is Complete – IW Annuity Plan

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