Healthcare

Summary of Benefits Coverage

  1. Cigna Vision Summary of Benefits (applies to GEA members only) (PDF)
  2. State of Connecticut Partnership Plan Anthem
  3. State of Connecticut Partnership Plan Medical Benefit Summary (applies to GEA members only) (PDF)
  4. State of Connecticut Partnership Plan Medical Benefit Summary (PDF)
  5. State of Connecticut Partnership Plan UnitedHealthcare Oxford (PDF)

Forms

  1. Anthem Claim Form
  2. Cigna Dental Claim Form (PDF)
  3. Cigna Vision Claim (PDF)
  4. CVS Caremark Mail Service Order Form (PDF)
  5. CVS caremark Prescription Reimbursement Claim Form (PDF)
  6. MetLife Dental Claim Form (PDF)
  7. UnitedHealthcare Oxford Claim Form (PDF)
  8. Vision Hardware Reimbursement GMEA (PDF)
  9. Vision Hardware Reimbursement LIUNA (PDF)
  10. Vision Hardware Reimbursement M&C (PDF)
  11. Vision Hardware Reimbursement UPSEU (PDF)

Qualifying Life Events

  1. Enrollment Change Requirements (PDF)

Important Information & Annual Notices

  1. 2020 Med D Creditable Coverage Letter (PDF)
  2. COBRA Notice (PDF)
  3. HIPAA Form Notice of Privacy Practices (PDF)
  4. HIPAA Special Enrollment Rights and Womens Cancer Rights Act (PDF)
  5. Premium Assistance Under Medicaid And The Children (CHIPRA) (PDF)

Dental Plan Descriptions

  1. Cigna Dental_Police_2019_7_1
  2. Cigna Dental_Teamsters_2019_7_1
  3. Cigna Dental_Nurses_2019_7_1
  4. Cigna Dental_MC_2019_7_1
  5. Cigna Dental_LIUNA_2019_7_1
  1. Cigna Dental_GMEA_2019_7_1
  2. Cigna Dental_GEA_2019_7_1
  3. Cigna Dental_Fire_2019_7_1
  4. Cigna Dental_LIUNA BOE_2020_7_1
  5. Cigna Dental_ GOSA_2020_7_1