Benefits Office
WELFARE (MEDICARE PARTICIPANTS 65 & OVER)
Welfare Summary Plan C Description - Medicare / 65 & Over
Forms
Forms
Authorization for Release of Health Information
Claim Reimbursement Form
Dental Out-of-Network Member Claim Form
Letter of Medical Necessity Template
Notice of Privacy Practices Form
Waiver of Coverage Form
Benefits / Resources
COBRA Coverage (See Section C - "COBRA CONTINUATION COVERAGE")
Death
Dental
Medicare & Prescription Drug (MAPD)
Medicare-B Reimbursement (See Section "Medicare Part B Premium Reimbursement")
Vision