Phone: 877-347-7225

Fax: 516-740-5410

Plan A Benefits

Welcome Letter

Enrollment Card

COB Questionnaire Form

HIPAA Privacy Practices


Welfare Summary Plan Description (SPD) / Summary of Material Modification (SMM)

SMM – COVID-19 Coverage

Summary Annual Report (SAR)

Summary of Benefits and Coverage (SBC)


Information on Medical Benefits

Anthem Empire BlueCross/BlueSheild

Empire BlueCross/BlueSheild PPO Welcome Flyer

Empire BlueCross/BlueSheild Lab Info

MAXOR Pharmacy Benefit Management(PBM)

Dental Coverage

Vision Providers (Eyeglasses) CPS Optical

Vision Providers (Eyeglasses) Vision Screening

Health Insurance Claim Form

The Hartford


Call us today - 877-347-7225

Disclaimer: Please remember the information provided on this website is for informational purposes only and is not a substitute for the Funds’ Plan documents. If there are any differences between the information on this website and the Funds’ Plan documents or other rules and regulations governing the Plans, the Funds’ Plan documents and other rules and regulations will always govern.
Links to provider websites are included for your benefit; the providers are solely responsible for the content of their own websites.

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