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