Select Page

Active Health & Welfare – Plan Documents & Forms

Fillable PDF Forms

Some PDF forms on this site are fillable online.  You can type information directly onto the PDF.
By default, Firefox does not currently support forms in fillable format.  To use this feature, view the site in Chrome or Microsoft Edge.

Plan Documents & Amendments
Summary of Benefits & Coverage

Active HW – Plan A
Plan A-Anthem SBC
Plan A-Kaiser SBC

Active HW – Plan B
Plan B-Anthem SBC
Plan B-Kaiser SBC

Active HW – Plan C
Plan C-Anthem SBC
Plan C-Kaiser SBC

Active HW – Plan K20
Plan K20-Kaiser SBC

Active HW – Plan K500
Plan K500-Kaiser SBC

Active HW – Plan K1000
Plan K1000-Kaiser SBC

General Forms
General Notices
Summary Annual Report