MemberXG Benefit system

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Summary Plan Description Booklets

Insert to Plan I SPD
FELRA Plan I Retiree SPD
Insert to Plan I Retiree SPD
FELRA Active Plan X SPD
Insert to Plan X SPD
FELRA Active Plan XX SPD
Insert to Plan XX SPD
Insert to Plan XXX
FELRA Active Plan XL SPD
Insert to Plan XL SPD

Download Summary of Benefits and Coverage

FELRA Plan 1 2019 SBC
FELRA Plan X 2019 SBC
FELRA Plan XX 2019 SBC
Kaiser Plans I & X 2018-19 SBC
Kaiser Plans X & XX 2018-19 SBC

Open Enrollment

Kaiser Permanente 2018-19 Open Enrollment: Plans I & X (enrolled)
Kaiser Permanente 2018-19 Open Enrollment: Plans XX & XXX

Downloads (Forms)

Accident & Sickness Application
Coordination of Benefits Form
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
2019 Express Scripts National Preferred Formulary List

Important Notices

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

Retiree Information

FELRA Non-Discrimination Notice
FELRA Retiree Co-Pay Rate Chart – Jan. 2019

Useful Links

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

Useful Numbers

Express Scripts 800-903-8325

Group Dental Service 800-242-0450

SHPS/Carewise Health 866-511-1462

Advantica 866-425-2323

Beacon Health Options 800-353-3572

Health Dialog 866-469-6331

For Your Benefit Newsletters

June 2019

March 2019
December 2018
September 2018

June 2018

March 2018
December 2017

September 2017
June 2017
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.