Click on any of the links below to download that Document as a pdf file:
When reading the Summary Plan Description (SPD), please also be sure to read the Summary of Material Modifications (SMM) below as they will have the most recent Plan changes.
H&W Summary Plan Description (SPD): Download
SMM #1 Download
SMM #2 Download
SMM #3 Download
SMM #4 Download
SMM #5 Download
SMM #6 Download
SMM #7 Download
SMM #8 Download
Summary of Benefits and Coverage: The Summary of Benefits and Coverage provides a summary of what is covered by the Plan.
Document: Download
Pension Summary Plan Description (SPD): Download
Annual Funding Notice: Download
Notice of Plan Status: Download
VAPP SPD: Download
VAPP Annual Funding Notice: Download
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...change my address?
...order a new ID card?
...file an out-of-network claim?
...designate a beneficiary?
...add a dependent?
...file for disability benefits?
...setup direct deposit for my pension check?
...apply for a pension?
Health & Welfare SPD Download the Health & Welfare SPD
Summary of Benefits and Coverage Download the Summary of Benefits and Coverage Document.
Ancillary Benefits Package Download Ancillary Benefits Package Document.
Change Healthcare Data Breech Notice. Download the Change Healthcare Data Breech Notice.
Authorization for Release of PHI Form. Download the Authorization for Release of PHI Form.
Beneficiary Designation Form Beneficiary Designation Form
Change of Name Form Download a Change of Name Form
Change of Address Form Download a Change of Address Form
COBRA Election Form Download a COBRA Election Form
Initial Disability Form Download the Initial Disability Form.
Disability Supplement Form Download the Disability Supplement Form.
Employer's Statement for Disability Form Download the Employer's Statement for Disability Form.
Life Insurance Summary Download the Life Insurance Summary.
Pension SPD Download the Pension SPD.
Pension Application Form Download the Pension Application Form.
Minnesota Withholding Form Download the Minnesota Withholding Form.
W-4P Tax Form Download the W-4P Tax Form.
VAPP SPD Download the VAPP SPD.
BCBS Senior Gold Plan Overview
Eligible for Medicare prior to 1/1/2020 Document. Download the Eligible for Medicare prior to 1/1/2020 Document.
Eligible for Medicare after 1/1/2020 Document. Download the Eligible for Medicare after 1/1/2020 Document.
Notice of Creditable Coverage Document. Download the Notice of Creditable Coverage Document.
Vision Claim Form - Bloomington Office Download the Vision Claim Form - Bloomington Office
Vision Claim Form - Duluth Office Download the Vision Claim Form - Duluth Office
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