Healthcare

Summary of Benefits Coverage

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

Forms

  1. Cigna Dental Claim Form (applies to GEA members only) (PDF)
  2. Cigna Vision Claim (PDF)
  3. CVS Caremark Mail Service Order Form (PDF)
  4. CVS caremark Prescription Reimbursement Claim Form (PDF)
  5. MetLife Dental Claim Form (PDF)
  6. UnitedHealthcare Oxford Claim Form (PDF)
  7. Vision Hardware Reimbursement GMEA (PDF)
  8. Vision Hardware Reimbursement LIUNA and MandC (PDF)
  9. Vision Hardware Reimbursement UPSEU (PDF)

Qualifying Life Events

  1. Enrollment Change Requirements (PDF)

Important Information & Annual Notices

  1. COBRA Notice (PDF)
  2. HIPAA Form Notice of Privacy Practices (PDF)
  3. HIPAA Special Enrollment Rights and Womens Cancer Rights Act (PDF)
  4. Premium Assistance Under Medicaid And The Children (CHIPRA) (PDF)
  5. State Partnership Plan Medicare Part D Credible Coverage Notice (PDF)

Dental Plan Descriptions

  1. Firefighters Dental Plan Summary (PDF)
  2. GEA Dental (PDF)
  3. GMEA Dental Plan Summary (PDF)
  4. GOSA Dental Plan Summary (PDF)
  5. LIUNA BOE Dental Plan Summary (PDF)
  1. LIUNA Dental Plan Summary (PDF)
  2. M and C Dental (PDF)
  3. Police Dental Plan Summary (PDF)
  4. Teamsters Dental Plan Summary (PDF)
  5. UPSEU Dental Plan Summary (PDF)