Enrollment & Beneficiary Form
Change of Address
VSP Enrollment Form
ULLICO Enrollment Form
Authorization to Disclose PHI
UnitedHealthcare Enrollment Form
Delta Dental Enrollment Form
Your Rights and Protections Against Surprise Medical Bills
Prescription Drug Coverage and Medicare Notice
UnitedHealthcare of California Combined Evidence of Coverage and Disclosure Form
VSP Grievance Process And Timely Access To Care Notice
SignatureValue Harmony HMO Summary of Benefits and Coverage
SignatureValue Harmony HMO Schedule of Benefits
SignatureValue Advantage HMO Schedule of Benefits
SignatureValue Advantage HMO Summary of Benefits and Coverage
2013 HIPAA Privacy Notice
Summary Plan Description - July 2021
Group Vision Care Plan Evidence of Coverage & Disclosure Form
SCPT 401(K) Participant Notice
Summary Plan Description - May 2021
Death Benefit Application
SCPT Defined Contribution Beneficiary Designation Form
SCPT Defined Contribution Enrollment Change Form
Declaration of Retirement
Inland Distribution Election Form
Paid Time Off Benefit Interim Withdrawal Form
Authorization Agreement For Direct Deposit
SMM Paid Time Off - April 2016
SMM Changes to Paid Time Off (PTO) Benefits - June 2017
401(k) Enrollment/Change/Opt-Out Form
Inactive Status Request Form
Contribution Payment Methods
Managing Contribution Benefits
Benefit information varies by Trust Funds. Please make a selection.
