Health Care
Medical Insurance
- Summary Plan Description (pdf)
- Summary Table of Benefits (pdf)
- Preferred Provider Search/Directory
(Plan Type - Care Plus) - After Hours Physicians List
(Southern Utah County) - Traveling Out of State - Coverage Information
- Enrollment/Change Form (pdf)
- Reimbursement Form (pdf)
- Electronic Explanation of Benefits
- Notice of Privacy Practices (pdf)
- COBRA Notice (pdf)
Dental Insurance
- Summary Plan Description (pdf)
- Summary Table of Benefits (pdf)
- Preferred Provider Search/Directory
(Plan Type - Premier) - Enrollment/Change Form (pdf)
- Electronic Explanation of Benefits
Prescription (Rx)
- Summary Plan Description (pdf)
- Summary Table of Benefits (pdf)
- Preferred Drug List/Formulary (pdf)
(Preferred Prescription Formulary) - Medco Online Services
(Secure Account Access, Find A Local Pharmacy, Price Medication, Refill & Renewal Of Prescriptions, etc.) - Price Your Medication Using The NEW 2007/2008 Plan Benefits
(Pay for your portion of medications tax free by enrolling in a Flexible Spending Account -> Available during open enrollment only, the month of April.) - Enrollment/Change Form (pdf)
- Reimbursement Form (pdf)
- Mail Order (90 day supply) (pdf)*
*Mail your prescription(s) along with the above completed form to:
Medco
PO BOX 30493
Tampa, FL 33630-3493
Vision
- Summary Plan Description (pdf)
- Summary Table of Benefits (pdf)
- Enrollment/Change Form (pdf)
- Reimbursement Form (pdf)
- Electronic Explanation of Benefits
