Human|Resources > Employee Benefits > Plan Descriptions and Forms

SUMMARY PLAN DESCRIPTIONS FOR MEDICAL INSURANCE

refer to your employee group for the medical plan(s) offered to you

• BlueChoice 3-TIER POS Medical Plan Summary
• Matthew Thornton Blue HMO Medical Plan Summary
• JW Medical Plan Summary
• JY Medical Plan Summary
• Managed Care Guidelines (for JW, JY, or C2500 plans)
• C2500 Managed Care Indemnity Plan with Rx copays of $10/$20/$45
• Matthew Thornton Blue HMO 2 with $15 Inpatient deductible; Rx copays of $10/$20/$45
• Caremark Prescription Benefit Program with prescription co-pays of $10/$20/$45

DENTAL PLAN OPTIONS

refer to your employee group for the dental plan(s) offered to you

• Delta Dental Option 8
• Delta Dental Option 3A
• Dental Dental Option 4B
• Delta Dental Option 3 

FORMS NEEDED TO ENROLL OR MAKE CHANGES TO

MEDICAL AND/OR DENTAL INSURANCE

• Medical and/or Dental Application and Change Form

• Civil Union Partner – Certificate of Tax Dependent Status

• Request for Certification for a Mentally or Physically Incapacitated Dependent Child

• Notice of Divorce, Legal Separation, or Dissolution of Civil Union