NETime Benefit system

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Summary Plan Description Booklets
Plan X Active Health & Welfare Plan SPD
Insert to Plan X SPD
Plan XX Active Health & Welfare SPD
Insert to Plan XX SPD
Eligibility for Plan XXX and Plan XL
Plan I SPD
SMMs (Benefit Changes) to FELRA Plan I SPD
Plan I Retiree SPD
SMMs (Benefit Changes) to FELRA Plan I Retiree SPD
Insert to Plan XXX

Download Summary of Benefits and Coverage

FELRA Plan 1 2017 SBC
FELRA Plan X 2017 SBC
FELRA Plan XX 2017 SBC

Benefit Summaries

FELRA Plan XX Benefit Summary 2015
FELRA Plan XXX Benefit Summary 2015

Downloads (Forms)

Accident & Sickness Application
Coordination of Benefits Form
Kaiser HMO Option for Plans I and X
Kaiser HMO Option for Plan XX
HIPAA Authorization Form
LabCorp Facility List
Notice of Continuation or Termination of Disability for Group Accident & Sickness Benefits
Subrogation Agreements
Express Scripts Excluded Medications with Covered Preferred Alternative
2016 Express Scripts National Preferred Formulary List

Important Notices

FELRA – ACA Preventive Services
Notice of Privacy Practices
Prescription DrugMedicare Creditable Coverage

Retiree Information

FELRA Non-Discrimination Notice

Useful Links

CareFirst PPO
Group Dental Services of MD
Health Dialog
Kaiser Permanente
Medco Health Solutions, Inc
UFCW Local 400
UFCW Local 27
Value Options

Useful Numbers

Express Scripts 800-903-8325

Group Dental Service 800-242-0450

SHPS/Carewise Health 866-511-1462

Advantica 866-425-2323

Value Options 800-353-3572

Health Dialog 866-469-6331

For Your Benefit Newsletters

March 2017
December 2016
September 2016
June 2016
March 2016
December 2015
September 2015
June 2015
March 2015
December 2014
September 2014
June 2014
March 2014
December 2013
September 2013
June 2013
March 2013
December 2012
September 2012
June 2012
March 2012

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.