Insurance
Plan Documents
- Meritain – 15093-0915 — Medical, Dental, and Health Reimbursement Arrangement (HRA)
- Meritain – 15093-0915-Flex — Flexible Spending Account (FSA)
- Superior Vision — Vision
- Reliance Standard (LTD) — Long Term Disability
- Standard Insurance (NEA Life) — Life Insurance
2018 Benefits Notices
- CHIPRA Notice
- Creditable Coverage Disclosure Notice
- Enrollment Form
- Guide to Flexible Spending_2018
- Marketplace Notice
- Women’s Health Cancer Rights Act Notice
2017 Benefits Notices
- SBC — Summary of Benefits and Coverage
- CHIP Model Notice — Notice regarding premium assistance under Medicaid/Children’s Health Insurance Program
- Creditable Coverage Disclosure Notice 2017 — Information about coordinating FEA prescription drug coverage with Medicare Part D
- Women’s Health Notice — Notice of rights under the Women’s Health and Cancer Rights Act of 1998
FSA Information
- MH_Members-Flyer_Member-Portal-FAQ_WEX — NEW!!! Information about submitting FSA claims on Meritain’s website
- FSA Mini Kit — Contains information and forms involved in using your FSA
- FSA Reimbursement Request Form — Make a paper claim for reimbursement from your FSA
- FSA Direct Deposit Form — Authorize Meritain to deposit FSA reimbursements directly into your bank account
- Please note: the addresses on the Reimbursement Request Form and the Direct Deposit Form are different! This is not a mistake! Please make sure you send each form to their respective addresses.