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Benefits Information & Forms

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Resources

Available Benefit Plan Options

2021 Renewal Packet

Glossary of Health Coverage and Medical Terms

Glossary of Terms

Disclosures of Creditable Coverage

2020 Creditable Letter and Disclosure

2020 Benefit Highlight Sheets

1000 PPO Plan with Copay Rx Option

1000 PPO Plan with Deductible Rx Option

1750 PPO Plan with Copay Rx Option

1750 PPO Plan with Deductible Rx Option

2750 PPO Plan with Copay Rx Option

2750 PPO Plan with Deductible Rx Option

3250 PPO Plan with Copay Rx Option

3250 PPO Plan with Deductible Rx Option

3000 High Deductible Health Plan

5000 PPO Plan with Copay Rx Option

5000 PPO Plan with Deductible Rx Option

Delta Dental

Vision Plan Benefits

2021 Benefit Highlight Sheets

1000 PPO Plan with Copay Rx Option

1000 PPO Plan with Deductible Rx Option

1750 PPO Plan with Copay Rx Option

1750 PPO Plan with Deductible Rx Option

2750 PPO Plan with Copay Rx Option

2750 PPO Plan with Deductible Rx Option

3250 PPO Plan with Copay Rx Option

3250 PPO Plan with Deductible Rx Option

3000 High Deductible Health Plan

5000 PPO Plan with Copay Rx Option

5000 PPO Plan with Deductible Rx Option

Delta Dental

Vision Plan Benefits

Summary Plan Descriptions (SPD)

1000 PPO Plan SPD with RX Copay Option

1000 PPO Plan SPD with RX Deductible Option

1750 PPO Plan SPD with RX Copay Option

1750 PPO Plan SPD with RX Deductible Option

2750 PPO Plan SPD with RX Copay Option

2750 PPO Plan SPD with RX Deductible Option

3250 PPO Plan SPD with RX Copay Option

3250 PPO Plan SPD with RX Deductible Option

3000 High Deductible Health Plan SPD

5000 PPO Plan SPD with RX Copay Option

5000 PPO Plan SPD with RX Deductible Option

Benefits Change Notice

2020 Summary of Benefit Changes

Plan Comparison Summary

2020 Basic Plan Comparison

2020 Deluxe Plan Comparison

2020 Plan Updates

2020 Plan Updates

Health Plan Forms

Census Form

Waiver of Coverage

Cancellation Form

Idaho AGC Group Application

Leave of Absence Form

Claim Forms

Blue Cross of Idaho Claim Form

Prescription Drug Claim Form

Symetra Life, STD, and Accident Coverage and Forms

Enrollment Form

Life Only Enrollment Form

Evidence of Insurability Form (EOI)

Accident Enrollment Form 

Optional Life Summary

Short Term Disability Summary

Optional STD Buy-Up Rates - Class 1

Optional STD Buy-Up Rates - Class 2

Basic Life and AD&D Summary

Accident Summary

Value-Added Discounts & Services

Blue Cross of Idaho

Blue Extras

Delta Dental

Health through Oral Wellness (HOW) - maximize oral health with no additional cost

DDID Amplifon Hearing Aid 

Orthodontic Discount Providers

Mobile App 

VSP Member

VSP Exclusive Extras

Symetra

Employee Assistance Program (EAP)

Beneficiary Companion

Health Champion

Identify Theft Resolution Program

Travel Assistance Program

Customer Complaint Handling Procedures

Filing a Complaint