Forms and information

What to do...

• If you're sick
• If you're pregnant
• If you have an accident
• If you get hurt at work
• If you want to quit smoking
• If you're scheduled for surgery

Medical help and services

• COVID-19 (Coronavirus)
• Feeling sick?
• Find a doctor
• The Culinary Health Center
• Dr. Tomorrow
• Urgent care centers
• Hospitals
• Vision
• Lab work
• Mammograms
• Advocates
• Healthy Pregnancy Plus program
• Chiropractors
• Acupuncture
• Autism Spectrum Disorder
• Mental health
• Addiction
• Durable medical equipment
• Diabetes Passport program

Medicine and prescriptions

• Pharmacy information
• Find a pharmacy
• Medicine available at the Culinary PharmaciesDownload PDF
• Prescription refills
  • By mail
  • Online
• Specialty pharmacy
• Durable medical equipment

Women's health

• Mammograms
• Healthy pregnancy information
  • Healthy Pregnancy Plus program
  • Breastfeeding classes

Healthy living

• Stop smoking help
• Weight loss help
• List of all upcoming healthy living classes
• Breastfeeding classes
• Diabetes classes
  • Diabetes Passport program
• Healthy cooking classes
  • Healthy cooking recipes
  • Healthy cooking videos
• High blood pressure classes

Dental information

• Dental care
  • In-network dental benefits
  • Out-of-network dental benefits

• Eligibility information
  • Eligibility calculator
  • Check my eligibility
• Self-pay
  • Self-pay calculator
• Copay information
  • Copay bookDownload PDF
  • In-network dental copays
  • Out-of-network dental copays
• Check my claim status
• Workersʼ Compensation

Forms

• Alternate other health insurance (OHI) verification formDownload PDF
• Appeal request form and guideDownload PDF
• COBRA continuation coverage formDownload PDF
• Continuity of care request formDownload PDF
• Enrollment packetDownload PDF
• Extended eligibility applicationDownload PDF
• Life insurance beneficiary designation formDownload PDF
• Loss of time form and checklistDownload PDF
• Medical and vision claim formDownload PDF
• Non-union to union classification transferDownload PDF
• Plan 150 enrollment formDownload PDF
• Prescription refills by mail formDownload PDF
• Protected health information (PHI) release authorizationDownload PDF
• Retiree enrollment applicationDownload PDF
• Waiver of coverage for the Culinary Health Fund PlanDownload PDF

Documents and guides

• Copay bookDownload PDF
• Dental bookDownload PDF
• How to sign up for the Participant Portal
• Medical and coverage definitions
• Medicare Part D noticeDownload PDF
• Medicine available at the Culinary PharmaciesDownload PDF
• Participant guideDownload PDF
• Preferred drug listDownload PDF
• Specialty drug listDownload PDF
• Summary annual report (SAR)Download PDF
• Summary of benefits and coverage (SBC)
• Summary Plan Description (SPD)
• Women’s Health and Cancer Rights Act annual noticeDownload PDF
• Your Rights and Protections Against Surprise Medical BillsDownload PDF

Everything else

• Contacts
• Life insurance
• Participating employers
• Participating unions
• John Wilhelm Endowed Scholarship
• Capitated services
• Customer Service app
  • Android
  • Apple