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MemberXG Benefit system

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Glossary of  Health Coverage and Medical Terms

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Full-Time Medical Plan (FT)

Provider Locator:  Anthem.com  or 1-800-810-BLUE

Provider contact for benefit verification:  1-800-676-BLUE

Member contact:  Associated Administrators, LLC 1-855-266-1500

Pre-certification of services: Healthlink Medical Management:  1-877-284-0102

Mental Health/Substance Abuse pre-certification through LICADD:  1-516-747-2606

(Long Island Council on Abuse and Drug Dependence)

Prescription Plan Information: Express-Scripts.com  or 1-877-861-8145

Download FT Plan Forms

Full-Time Plan – Change of Address Form

Full-Time Plan – Spousal Enrollment Form

Full-Time Plan – Preventive Services Benefit List

Full-Time Plan – Subrogation Agreement

Full-Time Plan – Coordination of Benefits Questionnaire

Full-Time Plan – HIPAA Authorization Form

Full-Time Plan – Third Party Change of Address Form

Hand-outs from Feb 2014 area meetings

Summary of Material Modifications (SMMs)

Full-Time Plan – Summary of Material Modifications – July 21, 2015

Full-Time Plan – Summary of Material Modifications – February 1, 2015

Full-Time Plan – Summary of Material Modifications – December 29, 2014

Full-Time Plan – Summary of Material Modifications – October 2, 2014

Full-Time Plan – Summary of Material Modifications – December 30, 2013

Summary of Benefits and Coverage (SBC)

Full-Time Plan Coverage Period January 1 – December 31, 2017

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 Special Part-Time Medical Plan (SPT)

Provider Locator: Anthem.com  or 1-800-810-BLUE

Benefit Information: Associated Administrators, LLC: 1-855-266-1500

Prescription Plan Information: Express-Scripts.com  or 1-877-861-8145

Pre-certification Services: Healthlink Medical Management: 1-877-284-0102

Download SPT Plan Forms

Special Part-Time Plan – Change of Address Form

Special Part-Time Plan – Preventive Services Benefit List

Special Part-Time Plan – Subrogation Agreement

Special Part-Time Plan – Coordination of Benefits Questionnaire

Special Part-Time Plan – HIPAA Authorization Form

Special Part-Time Plan – Third Party Change of Address Form

Hand-outs from Feb 2014 area meetings

Summary of Material Modifications (SMMs)

Special Part-Time Plan – Summary of Material Modifications – July 1, 2015

Special Part-Time Plan – Summary of Material Modifications – April 30, 2015

Special Part-Time Plan – Summary of Material Modifications – February 1, 2015

Special Part-Time Plan – Summary of Material Modifications – December 29, 2014

Special Part-Time Plan – Summary of Material Modifications – September 30, 2014

Special Part-Time Plan – Summary of Material Modifications – December 30, 2013

Summary of Benefits and Coverage (SBC)

Special Part-Time Plan Coverage Period January 1 – December 31, 2017

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Part-Time ACA Medical Plan (A)

Provider Locator:  Anthem.com  or 1-800-810-BLUE

Provider contact for benefit verification:  1-800-676-BLUE

Member contact:  Associated Administrators, LLC 1-855-266-1500

Pre-certification of services: HealthLink Medical Management:  1-877-284-0102

Mental Health/Substance Abuse services through LICADD:  1-516-747-2606

(Long Island Council on Abuse and Drug Dependence)

Prescription Plan Information: Express-Scripts.com  or 1-877-861-8145

 

Download  PT ACA Plan Forms

Part-Time ACA Plan – Change of Address Form

Part-Time ACA Plan – Third Party Change of Address Form

Part-Time ACA Plan Preventive Services Benefit List

Part-Time ACA Plan – Subrogation Agreement

Part-Time ACA Plan – HIPAA Authorization Form

Part-Time ACA Plan – Outline of Benefits

Summary of Material Modifications (SMMs)

Part-Time ACA Plan – Summary of Material Modifications – July 21, 2015

Part-Time ACA Plan – Summary of Material Modifications – December 29, 2014

Summary of Benefits and Coverage (SBC)

Part-Time ACA Plan Coverage Period January 1 – December 31, 2017

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Download Basic Part-Time Forms

Part-Time Plan – Change of Address

Part-Time Plan – Third Party Change of Address Form

Summary of Material Modifications (SMMs)

Part-Time Plan – Summary of Material Modifications

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Useful Links

New York State – The Official Health Plan Marketplace

UFCW 1500 Union website

Dental Providers

Integrated Dental Administrators, Inc.
1-855-UFCW-1500

Integrated Dental Brochure

 Vision Providers

CPS Optical Website

CPS Optical Brochure

General Vision Services Website

 General Vision Benefits & Provider Locations

Vision Screening Inc. Website

Vision Screening Inc. Brochure

These forms are published on this page by Associated Administrators, LLC on behalf of the Client Fund and are meant solely for the use of their participants.