Sunday, February 07, 2016


Sheet Metal Workers Union Local 104

Member Fringe Benefit Website

Health Care Plan Information

Please use the site menu to navigate to detailed information on the summary plan description. For general health related frequently asked questions (FAQs) and links, please see information on this page! 

If you have any questions or would like clarification, you can request additional information by calling the Benefit Fund Office. Your questions may be referred to the Board of Trustees.

Health Care Links  Health Care Links

Health Care Documents  Health Care Documents
2013 HRA Annual and Interest Allocation NoticeDownload
Address Verification Change Form Download
Benefit Summary - Senior Advantage with Part D (9-1-13 - 8-31-14)Download
Benny Card FAQ Download
Benny Card IIAS Merchant ListingDownload
Benny Card Introduction LetterDownload
Blue Shield Reimbursement Form Download
Delta Dental PPO Summary of BenefitsDownload
Enrollment Form Download
Enrollment Form for Dependents Ages 19-25Download
Envision Pharmacy Coordination of Benefits Download
Envision Pharmacy Direct Claims Download
HIPAA Privacy Instructions and Form Download
HRA FormDownload
Indemnity Health Plan - Summary of Benefits (SBC) - 7/1/14 to 6/30/15Download
Kaiser Chiropractic Provider Directory 2011Download
Kaiser Permanente Enrollment Form Download
Kaiser Summary of Benefits Coverage - Utility Workers - 9/1/13 - 8/31/14Download
Medical Claim Form - DisabilityDownload
Preventive Services Covered Under the Affordable Care ActDownload
Statement of Medical Claim Download
Summary of Material Modification - Annual Maximums and Dependents Ages 19-25 CoverageDownload
VSP Summary of BenefitsDownload

Health Care FAQs  Health Care FAQs

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