Plan Documents

 
Title Date Sort ascending
2020 Domestic Partner Declaration Form
City & County of SF Employees, SF Unified School District Employees, City College of SF Employees, Municipal Executive Employees, Retirees, Getting Ready to Retiree, Retirees with Medicare, Retirees without Medicare, Superior Court of SF Employees, 2020
May 6, 2020 Download
HIPAA Complaint of Violation
City & County of SF Employees, SF Unified School District Employees, City College of SF Employees, Municipal Executive Employees, Retirees, Superior Court of SF Employees, 2020
May 6, 2020 Download
UHC Medicare Advantage PPO (MAPD) Prescription Claim Form
Retirees, Retirees with Medicare, UnitedHealthcare PPO, UHC City Plan PPO, 2020
January 23, 2020 Download
2020 Evidence of Coverage (EOC) Kaiser Permanente Senior Advantage HMO Washington (Medicare)
Kaiser Permanente Senior Advantage HMO - Multi-Region, 2020
December 27, 2019 Download
2020 Evidence of Coverage (EOC) Kaiser Washington (Non-Medicare)
Kaiser Permanente HMO, Kaiser Permanente HMO - Multi-Region, 2020
December 27, 2019 Download
2020 Evidence of Coverage (EOC) Senior Advantage HMO Kaiser Northwest (Medicare)
Retirees, Retirees with Medicare, Kaiser Permanente Senior Advantage HMO - Multi-Region, 2020
December 27, 2019 Download
2020 Retirees Without Medicare Premium Rates
Retirees, Getting Ready to Retiree, Retirees without Medicare, Access+ HMO, Trio HMO, Kaiser Permanente HMO - California, Kaiser Permanente HMO - Multi-Region, UnitedHealthcare PPO, UHC City Plan PPO, VSP Vision, 2020
December 26, 2019 Download
2020 SFHSS Section 125 Cafeteria Plan
City & County of SF Employees, SF Unified School District Employees, City College of SF Employees, Municipal Executive Employees, Superior Court of SF Employees, 2020
December 26, 2019 Download